Yasim's Blog

Heroes of Running

yasimk@gmail.com (Yasim) — Wed, 16 Dec 2009 02:33:00 +0000

THE LEADER: ROBYN BENINCASA

This elite adventure racer has helped women beat the odds and live out their athletic dreams.

World-class adventure racer Robyn Benincasa has climbed the Himalayas in Nepal and trekked across lava fields in Fiji. So in 2007, when she was diagnosed with osteoarthritis and told she may never run again, Benincasa wasn't about to let a bad health report destroy her adventurous spirit. She underwent hip resurfacing surgery, and 16 weeks later, ran theSedona Marathon with her friend Melissa Cleary by her side. "That made me think of how great it would be to bring that kind of confidence and support to other women," she says. Months later, she launched Project Athena, a nonprofit that helps women who have suffered a medical setback live out their athletic dreams. Benincasa, a 42-year-old San Diego firefighter, recruited a team of accomplished female athletes to serve as coaches and mentors to the women who apply for and receive the foundation's "Athenaships." (Four have been awarded so far.) Sara Jones, a breast-cancer survivor, was one of the first recipients. In February, she raced a six-day ultramarathon in Costa Rica with the Project Athena team. "During the race I realized that the cancer can't stop me," she says. "I came away feeling powerful." Seeing that transformation is more rewarding for Benincasa and her team than medals and PRs. "All of our lives, we've been racing for spots on podiums," she says. "But now it's for something so different, so life-affirming. For some women who are battling a medical condition, being alive is not enough. They want their juju back! Doctors can cure their bodies, but we can cure their spirits."

THE WARRIOR: KEITH ZEIER

This marine ran a 100-mile race to raise money for the Special Operations Warrior Foundation.

Wasn't it enough that a sniper bullet missed, by centimeters, his head on an Easter morning in Fallujah? And wasn't it enough that weeks later he had to watch two of his fellow Marines get blown up when their Humvee ran over an IED, the same IED that his Humvee had avoided, seconds earlier? And wasn't it enough that he was nearly killed two months later when the Humvee he was in this time didn't miss an IED, and Keith Zeier—a perpetual-motion 20-year-old—was left with a left leg with virtually no sensation from knee to hip? Wasn't that enough anguish and pain?

No, Keith Zeier, will tell you, that wasn't enough. "Survivor's guilt," he says. "I'm alive and a bunch of my friends aren't. That keeps me motivated."

So last May, Zeier ran a 100-mile race from Key Largo to Key West, Florida. His mission: to raise money for the Special Operations Warrior Foundation, which provides financial assistance to wounded soldiers and college tuition to children of service men and women killed in action. Twenty-four hours aft er Zeier announced his attempt online, the foundation received $50,000 in pledges, the most ever in a one-day span. In total, Zeier, now 23, has raised $85,000, all with a leg he may have amputated one day.

Denise Zeier, Keith's mom, remembers her son was always in a rush as a kid. To soccer practice. To track meets. And to graduate from his Long Island high school so he could join the Marines. "He was 17, and he needed me to sign his papers," says Denise, a single mom. "Otherwise, the Marines won't take you until you're 18." But ever since September 11, 2001, all Keith wanted to be was a Marine. On that day, Lt. John Crisci of the New York City Fire Department, his best friend's dad and a father figure to Zeier, died in the World Trade Center. "Mr. Crisci would always be there for me," says Zeier, who's now hoping to join the FDNY. "He invited me wherever he and his sons went—soccer games, hockey games. After he died, I decided I wanted to be in the Special Operations. It was the least I could do."

Members of Special Operations are trained to undertake the most challenging operations. Zeier made Special Ops on his first attempt. But on July 17, 2006, less than five months into his Iraq deployment, his military career came to a crippling end with the roadside bombing. Shrapnel tore through his upper left thigh, severing nerves and causing massive bleeding. He had three operations in Fallujah, and then was transported to National Naval Medical Center in Bethesda, Maryland, for more surgery. A 12-inch scar is the external remnant of his troubles. Internally, "even though I have no sensation in my thigh," he says, "the rest of my leg hurts 24 hours a day."

Doctors told him to expect to use a cane the rest of his life. But after 20 months of physical therapy, Zeier attempted his 100-miler. By mile 75, following 21 hours of running, he lay on a Florida road being treated for dehydration and exhaustion. EMT officials recommended that he be taken to a hospital. Zeier wouldn't hear of it, signing a waiver refusing such treatment. Moments later, he started back up again. "Even if my legs weren't working," he recalls, "I was going to crawl to the finish." He finished the race in 31 hours, three minutes. "The mental aspects that got me through that day are the ones my buddies portray every day," he says. Then, remembering his buddies who will never return from Iraq, Zeier adds, "How could I quit on my friends who made the ultimate sacrifice?"

THE MENTOR: DICK TRAUM

This amputee has given disabled people the empowering experience of crossing a finish line.

There's a lot of groaning at the Saturday morning workouts of the Achilles Track Club in New York's Central Park, but it's not from physical exertion. No, the runners are rolling their eyes at Dick Traum's silly one-liners. When one athlete mentions she's heading to the salon after the workout, Traum, an above-the-knee amputee, deadpans, "Think they'd give me half price on a pedicure?" Another says he needs a new wheelchair. Traum doesn't miss a beat. "It does look like it's on its last leg." And all the amputees have heard Traum suggest they refuel at the pancake establishment whose name mirrors their running motion: IHOP.

For all his jokes, Traum, 68, who founded Achilles 26 years ago and is its president, couldn't be more serious about his work. He gets people with any kind of challenge—missing limbs, multiple sclerosis, visual impairments—and coaches them to finish races. Traum formed the club in 1983 with less than $1,000, mostly from his own pocket. That year, six disabled athletes finished the New York City Marathon. Today, there are about 150 Achilles chapters in more than 60 countries operating on a $1.7 million budget. More than 500 Achilles participants will finish marathons this year, and thousands will race shorter distances, like the Hope & Possibility Five-Milers in Central Park, Atlanta, and Madison, Wisconsin.

The purpose of Achilles has always been to integrate disabled athletes into mainstream events. "When an able-bodied runner gets passed by someone who is blind or on one leg, it changes their perception of what the disabled can do," Traum says.

Traum has a tried-and-true method for motivating Achilles newcomers. He gets them focused on a race. On an August morning, after a young man tries a handcrank wheelchair for the first time, Traum tells him to "mark November 7, 2010, on your calendar—that's when you'll be doing the New York City Marathon." The athlete sits silent, momentarily stunned by the idea, but Traum, the first amputee to run a marathon (New York City in 1976), has made similar pronouncements thousands of times. "We're trying to set up something for them to think about, a goal for them to meditate on," he says.

Traum has traveled to global hot spots like Chechnya and South Africa to set up chapters. A group has even formed in Kabul, Afghanistan. And he's always looking for new challenges. Can running help Alzheimer's patients? Kids with autism? Cancer patients undergoing chemotherapy? Traum has recruited members with all those afflictions—and gotten them racing.

When he was 24, Traum was crushed between two cars at a gas station; his right leg later had to be amputated. He completed 11 marathons on his prosthetic, but when he needed his left knee replaced 10 years ago, doctors advised him to use it sparingly. So the handcrank became his racing vehicle (in it, he's done 25 marathons). He lifts his sleeve to show off his biceps, which look like they belong in the dugout of Yankee Stadium.

But Traum is a coach first. He counts among his athletes people like Donald Arthur, who first walked the New York City Marathon in 1997, 15 months after a heart transplant. Arthur has since completed marathons in 30 states. "Our first conversation, I'm thinking this guy is crazy," Arthur says. "I just had a heart transplant and he's talking about a marathon." As Arthur, and thousands of others have learned, doing a marathon can transform a life. And even Traum would admit that's nothing to joke about.

THE HUMANITARIANS: PHIL CARLITZ & ANDREW HUDIS

These teens organized a race in Thailand to benefit refugee children.

It's the question they dread most: What did you do on your summer vacation? Not because Phil Carlitz and Andrew Hudis, both 16, spent their time slacking off or honing their Guitar Hero skills. No, the problem is conveying the magnitude of what they accomplished: Organizing a marathon in a remote province in Thailand, more than 8,000 miles from their homes in southeastern Pennsylvania, to raise money and awareness for a group of Myanmarese refugees.

"I took a driving lesson the other day, and the instructor asked me what I did for the summer," says Hudis. "I thought to myself, oh no. Even by the end of the lesson I don't think he understood."

The boys' transformation into running humanitarians began in the summer of 2008, when they signed up for Rustic Pathways, a global community service program for students. While traveling along the border of Thailand and Myanmar (formerly Burma), they met Karen people, a minority group persecuted by Myanmar's dictatorial government and forced to flee into Thailand where many are trapped in refugee camps, with little hope of an education, a job, or a future. Hudis and Carlitz were moved by the circumstances they saw Karen kids their own age facing: Many live in bamboo huts. With no money, they're forced to make their own clothes and grow their own food. And with their parents dead or stuck across the border, they basically raise themselves.

"In America, kids always complain about school," Hudis says. "But these refugees told us, 'All we want to do is go to university and learn.' You realize that we have it a lot easier than we think."

While still in Thailand, the passionate runners discussed running a marathon to raise money for an orphanage in Mae Sariang. But when they presented their notion to Rustic Pathways' founder, David Venning, he pushed them to think bigger. "Don't just run a marathon," he told them. "Run a marathon—right there in Mae Sariang."

It says something about the teenage mind—or at least about these particular teenage minds—that they didn't need any other encouragement than that. The boys started laying the groundwork for a race they would hold the following summer. They returned to the States for their sophomore years and continued their race preparations between student-council and debate-team meetings.

Finally, this past July, they traveled back to oversee the Rustic Pathways Tribe-to-Tribe Marathon. They had hoped for a few dozen runners, but 500 people—including people from Australia, Japan, England, and the United States—raced in the marathon, half, and 5-K. About $10,000 was raised for the orphanage. "In a country where a shirt costs 60 cents and you can eat for a quarter, that money goes pretty far," Hudis says. "We are putting 25 teenage refugees through high school." Just as important, the race raised awareness about the plight of the Karen people.

And they are going to do it again—Carlitz and Hudis have committed to the event for a decade, and hope to turn Tribe-to-Tribe into a destination race that raises $250,000 annually for the refugees. Of course, the two are not too young to realize they themselves may be the biggest beneficiaries. "It showed me how helping people really makes you feel," Carlitz says. "If I could do that for a living, you know, that's the job for me."

Awards and Recognitions

yasimk@gmail.com (Yasim) — Mon, 14 Dec 2009 01:57:00 +0000

18 minute plan, Managing Expectations and an optimist

yasimk@gmail.com (Yasim) — Fri, 14 Aug 2009 00:12:00 +0000

One of my favorite truisms is that change is always a threat when done to me, but it is an opportunity when done by me. Many people hate change because it is inflicted on them; someone else is making them do it. On the other hand, people change all the time and love it, because they go after something they want - a new venture, a new book, a new spouse, a new baby, a new home, a new career step. In fact, when change is someone's chance to act on personal goals, it is not even called change. It is just "my project."

A counter-intuitive tip for mastering change is to start by wallowing in the feelings of dread it arouses. The sheer nail-biting horror of it all. Get in touch with every negative aspect, all the things that could go wrong. Then figure out a way to get that negative force on your side. In short, "Dream your worst nightmare and invest in it."

This nightmare-first theory is not a pessimistic outlook on life. It appears that optimists are less afraid of their nightmares than pessimists. Pessimists are more likely to deny or avoid negative information. Optimists are more likely to look at the dark side, because they have the confidence to feel that they can do something about it. So let me wish you pleasant dreams. And also productive nightmares :)

"Positive thinking" and "counting blessings" can sound like naïve cliches. But energizers are not fools. They can be shrewd analysts who know their flaws and listen carefully to critics so that they can keep improving. Studies show that optimists are more likely to listen to negative information than pessimists, because they think they can do something about it. To keep moving through storms, energizers cultivate thick skins that shed negativity like a waterproof raincoat sheds drops of water. They are sometimes discouraged, but never victims.
###################### Managing Expectations ########################

We are constantly shocked by the things other people say and do or by the things they don't say and don't do. How can my boss have ignored me? How can my colleague have taken the credit? How can my employee have made that mistake? Can you believe my manager said that to me in front of all those other people? How can my partner be so inconsiderate? Why doesn't my spouse appreciate what I do for her?

The problem is not us. And it's not them. The problem is our expectations.
It's not that people behave well or badly. It's that we expect them to behave differently than they do. Even when they have proven our expectation wrong time and time again.

At this point, should you still be surprised when your boss for the 100th time doesn't invite you to a meeting? Or when you send a colleague a nice email and it goes unanswered? Again.
Here's my advice: don't go to a hardware store and get upset when they won't sell you milk.
In this case, the answer to frustration is acceptance. It's amazing how changing your expectations can change your experience.

Because the world is more global and organizations are more diverse, the likelihood we will interact with people very different from us is increasing exponentially. And people who are different from us do things we don't expect or want them to do. Sometimes they don't look at us when we speak to them. Sometimes they talk back. Sometimes they don't talk at all. They defy our expectations, and we feel frustrated.

Remember the golden rule? Treat other people the way you'd like to be treated? Forget it. It doesn't apply anymore, if it ever did. Try this new rule instead: Treat other people the way they'd like to be treated.

So instead of getting frustrated with other people, learn their rules of engagement. If you pretend each person is from a foreign country you don't fully understand, you'll be more open to accepting him or her.

Think of every interaction as an experiment that explains a little bit more about the individual you're dealing with. Then, when someone defies your expectations, don't get mad. Just change your expectations to more accurately align with reality. Once you understand your colleagues' operating instructions, you might decide to approach them differently.

Or you might decide to leave — to go and work somewhere else with other people. Because once you accept your colleagues, once you realize you simply can't buy milk at a hardware store, you might decide you don't want to be in a hardware store at all. I'm not saying people can't change. I'm just saying you're setting yourself up if you expect them to.

###################### 18 minute day plan ############################
Yesterday started with the best of intentions. I walked into my office in the morning with a vague sense of what I wanted to accomplish. Then I sat down, turned on my computer, and checked my email. Two hours later, after fighting several fires, solving other people's problems, and dealing with whatever happened to be thrown at me through my computer and phone, I could hardly remember what I had set out to accomplish when I first turned on my computer. I'd been ambushed. And I know better.

Jack LaLanne, the fitness guru, knows all about tricks; he's famous for handcuffing himself and then swimming a mile or more while towing large boats filled with people. But he's more than just a showman. He invented several exercise machines including the ones with pulleys and weight selectors in health clubs throughout the world. And his show, The Jack LaLanne Show, was the longest running television fitness program, on the air for 34 years.

But none of that is what impresses me. He has one trick that I believe is his real secret power -
Ritual.

At the age of 94, he still spends the first two hours of his day exercising. Ninety minutes lifting weights and 30 minutes swimming or walking. Every morning. He needs to do so to achieve his goals: on his 95th birthday he plans to swim from the coast of California to Santa Catalina Island, a distance of 20 miles. Also, as he is fond of saying, "I cannot afford to die. It will ruin my image."
So he works, consistently and deliberately, toward his goals. He does the same things day in and day out. He cares about his fitness and he's built it into his schedule.

Managing our time needs to become a ritual too. Not simply a list or a vague sense of our priorities. That's not consistent or deliberate. It needs to be an ongoing process we follow no matter what to keep us focused on our priorities throughout the day.

I think we can do it in three steps that take less than 18 minutes over an eight-hour workday.

STEP 1 (5 Minutes) Set Plan for Day. Before turning on your computer, sit down with a blank piece of paper and decide what will make this day highly successful. What can you realistically accomplish that will further your goals and allow you to leave at the end of the day feeling like you've been productive and successful? Write those things down.
Now, most importantly, take your calendar and schedule those things into time slots, placing the hardest and most important items at the beginning of the day. And by the beginning of the day I mean, if possible, before even checking your email. If your entire list does not fit into your calendar, reprioritize your list. There is tremendous power in deciding when and where you are going to do something.

STEP 2 (1 minute every hour) Refocus. Set your watch, phone, or computer to ring every hour. When it rings, take a deep breath, look at your list and ask yourself if you spent your last hour productively. Then look at your calendar and deliberately recommit to how you are going to use the next hour. Manage your day hour by hour. Don't let the hours manage you.

STEP 3 (5 minutes) Review. Shut off your computer and review your day. What worked? Where did you focus? Where did you get distracted? What did you learn that will help you be more productive tomorrow?

The power of rituals is their predictability. You do the same thing in the same way over and over again. And so the outcome of a ritual is predictable too. If you choose your focus deliberately and wisely and consistently remind yourself of that focus, you will stay focused. It's simple.
This particular ritual may not help you swim the English Channel while towing a cruise ship with your hands tied together. But it may just help you leave the office feeling productive and successful. And, at the end of the day, isn't that a higher priority

Ten Career Tips from the 2008 Presidential Campaigns

yasimk@gmail.com (Yasim) — Wed, 03 Dec 2008 03:37:00 +0000

Lessons from President-Elect Barack Obama and His Former Opponents

Now that the dust has settled with the US presidential election, the pundits can begin prognosticating on how Barack Obama will do the job. For those in the midst of a job search, however, attention must return to more mundane matters -- like getting a job in the first place.

Yet are there any job search and career-planning lessons that can be learned from the journey to Obama's historic victory? Here are 10 takeaways for your own job search and career:

Anyone Can Grow Up to Be President: And you can do any job you want as well. Set a goal, make sure you are qualified and apply yourself.
The Road to Success Is Long and Hard: Obama didn’t just decide to be president. First, he got an education. Then he worked in the community and was elected to the Senate. Then he ran for the Democratic nomination and then finally for president. While no one knows for sure where a path might lead, working hard each day pretty much guarantees progress.
Networking Is Crucial: Obama didn't do it by himself -- by some accounts, he had more than 1 million others helping him reach his goal. How are you using -- and growing -- your network?
The Internet Is an Important Tool: Beyond the basics of a Web site, Obama used blogs, videos, social networking, discussion groups, e-commerce and email. You too can use these media as ways to get the message out about what you can offer to employers.
A Personal Brand Is Powerful: More than anything else, Obama’s message was singular and on track: Change and hope. This focus defined Obama to others and helped these others amplify his message even further. It also helped that his brand was consistent across the way he looked, acted and sounded, as well as his message and attitude. While this might not be your personal brand, especially during a job search, you can institute the same consistency in how you present yourself and your message.
Maximize the Interview: Each time he was in front of the camera, Obama was poised, fluent and answered questions in an authentic manner. Most people don't enjoy interviews, so consider: Obama did five, 10 or more interviews each day. Practice makes perfect no matter what you’re interviewing for.
Get Support from Family and Friends: Often, a politician's family is wrongfully seen as a prop, to appear when needed and put away when completed. In reality, a public figure is also a private figure, with relationships, personal responsibilities and interests. Families are often the keystone to this private life, providing the support that allows politicians to work successfully in the public eye. Many of us who work -- or are looking for work -- sometimes forget that our families and friends are there to support us, and that it is our responsibility to reach out and ask.
Say Thank You: Obama's acceptance speech was both inspiring and humble. He didn't shirk from acknowledging the people who helped along the way. It isn't hard to say thank you, yet sometimes we easily forget.
Take a Rest Before You Start: No doubt Obama will use the time between election and inauguration to pull together his team, but he may also take a few days’ break to recharge from his long campaign. Likewise, if you are changing jobs, take a few days -- or even a week -- before you start your new position. That short break will leave you reenergized.
When You Step Up to the Plate, There Are No Losers: While John McCain and Sarah Palin lost the election, they also gained something from it. McCain earned 46 percent of the popular vote. He built a team and has become a greater influence within his party. Meanwhile, Palin put her name on the map, gaining valuable experience on a national stage. While neither won the prize they were seeking, both are further ahead than before, and this will help both McCain and Palin as they consider next steps.

When it comes to your own job search, even if you don't get the job -- or the promotion -- the fact you were considered says something about you. And the interview experience, networking and research have even greater value as you choose your next moves.

Toastmasters 10th Speech

yasimk@gmail.com (Yasim) — Mon, 20 Oct 2008 02:33:00 +0000

Spanking, grounding, and yelling: Does old-fashioned discipline work?

yasimk@gmail.com (Yasim) — Thu, 11 Sep 2008 17:41:00 +0000

Highlights

Spanking
Losing privileges
Time-outs
Grounding
Yelling
Forcing an apology
Put-downs

Your kid mouths off for the umpteenth time, and you've had it. Gone are your lofty notions of teachable moments. You yell, "Go to your room!" Moments later, as the words echo in your ear, you realize with a shock: I've become my mother.

You're not alone. The knee-jerk reaction when our kids misbehave is often to do exactly what we got as kids. The question is, do these old-school discipline tools stand the test of time?

We asked BabyCenter moms which of your parents' techniques you've used. Then we turned to a panel of experts to find out which are worth keeping in the discipline tool kit and which should be tossed in the trash.

Spanking

According to a BabyCenter poll, 85 percent of you were spanked as kids, and 69 percent of you do the same to your own children. A typical comment: "I was spanked when I deserved it. I think it kept me in line, and I spank my 2-year-old, too." Many parents say they only hit their child for downright dangerous behavior, like when a toddler runs into the street.

Some parents say a swat on the bottom is an effective discipline tool when all else fails — others call it child abuse. "I remember what I was wearing, how much she hit me, how I resisted, and the crying, pain, anger, and fear," writes one mom. "I do not remember the lesson or the deed."

What the experts say...

Toss it Spanking mostly shows that when you're bigger than someone it's okay to hit to show your anger or to hit to get your own way. The hurt, not the learning opportunity, becomes the message.

There are three good alternatives: isolation (like a time-out), deprivation (taking away a privilege), and reparation (where a child works to right a wrong before doing anything else). The goal is to get your child to think twice before making the same mistake.
— Carl Pickhardt, The Everything Parent's Guide to Positive Discipline

Toss it Spanking is a temporary solution that does more harm than good. It "works" because it's external control over a child, but it doesn't promote internal decision-making. It simply teaches children to behave — or else. Spanking causes many children to focus on the punishment rather than on their poor decision.

Spanking also has side effects. It's embarrassing, and that causes children to get angry or think about retaliation. Children who are frequently hit feel insecure. Many have poor self-esteem. Some withdraw. Others become excitable, overactive, and aggressive.
— Sal Severe, How to Behave So Your Children Will, Too!

Toss it How are we going to teach our children it's not okay to hurt others when we keep hurting them? For 2- to 4-year-olds, lots of supervision along with distraction and redirection are better tools. All the spanking in the world won't teach a child it isn't safe to run into a busy street until he's developmentally ready to learn that lesson.

Some children will push and push until they get a spanking and then settle down. They've been conditioned not to settle down or cooperate until they're spanked. Instead, try holding a disobedient child firmly on your lap. No matter how much she struggles, don't let go until she calms down or agrees to cooperate.
— Jane Nelsen, the Positive Discipline series

Losing privileges

Taking away something fun is a widely used tool for today's parents, many of whom picked up the habit from their own parents. "When I was naughty, my parents were quick to take away TV time or outings with friends," says one mom, who now does the same with her own son. "He loses screen time, ice cream, or sleepovers for repeated misbehavior. But I often think he just gets mad, and I wonder if he really learns anything from the experience."

For today's parents, the idea of redemption plays an important role. "I almost always give my children the opportunity to earn back a privilege easily and quickly if they acknowledge their error," says another mom of three.

What the experts say...

Keep it Revoking privileges is helpful when used sparingly. Choose a restriction that's easy to enforce — like taking toys away or sending your child to bed early — so you follow through. Pick a restriction that impacts the offender and no one else. Don't punish yourself!

Tell your child why you're taking something away, and choose a punishment that fits the crime: If your child turns on the TV after you tell him not to, unplug it for the night.

A common mistake is taking away privileges for too long. A week or two can feel like forever to a child. And it can backfire: Kids can get angry and resentful, seek revenge, and a cycle of retaliation begins. Remember: You want to encourage your child to do better next time. The best way is with positive reinforcement. "Great job, you finished all your chores. Now you can play outside until dinner."
—Sal Severe

Keep it Removing privileges is an appropriate consequence for repeated offenses, so long as it's something your child really cares about. Otherwise, it's fruitless. Make sure to choose something you have control over — watching TV, playing video games, or riding a bike. Avoid choosing something where your child's absence negatively affects others, such as soccer practice or a band performance.
— Michele Borba, No More Misbehavin'

Toss it Punishment just invites defiance, rebellion, or low self-esteem. If your child breaks something during a tantrum, you could take TV away for a week. But that won't teach him anything.

Instead, find a way for him to replace or repair the item. That might mean earning the money — even small children can do simple chores — or taking the money out of his piggy bank or allowance. Or perhaps he can sit with you and glue the item back together. This and many other nonpunitive methods are respectful and teach a child important life skills.
— Jane Nelsen

Time-outs

Our parents may not have called it a time-out, but make no mistake, they used it. Does "Go to your room" ring a bell? The time-out continues to be a favorite for parents of 2-year-olds, 3- to 4-year-olds, kindergartners, and grade-schoolers. (Parents of younger children may discover the technique doesn't work well yet.)

But not all time-outs are created equal. Some readers report using gentler methods than their parents did. "I was locked in my room fairly often and pounded on the door for attention. I didn't find that particularly educational," says one mom.

Another says, "After a warning, my son is put on the bottom step and is told why he's in time-out. The idea is for him to think about the choice he made. When it's over, we discuss why he was put in time-out and what he could do differently."

What the experts say...

Keep it Time-outs are effective if the child calms down, then thinks and talks about what happened and what he could do differently from now on. The purpose of isolation is not to ostracize or reject a child but to separate him from a problem situation.
— Carl Pickhardt

Keep it Time-outs are appropriate when a child is immediately removed for misbehavior and asked to sit alone quietly to think about her actions. It can be very effective at helping aggressive kids calm down.

One caveat: Time-outs should be customized to the age and temperament of your child and the severity of the misbehavior. The simplest rule for kids 3 to 7: Time-out is one minute for each year of the child's age. Set a timer so the child knows how long she's expected to remain.

To be effective, you must teach a replacement behavior. After the time-out, ask your kid to draw or write what she did wrong — or simply talk it out, asking her, "What will you do next time?" Older kids can make a statement of intent — a drawing, sentence, or a few lines explaining how they plan to change their behavior.
— Michele Borba

Keep it Time-out is recommended when the purpose is positive: To give a child a chance to take a break for a short time and try again as soon as he feels better. This cooling-off period allows a child to "do" better because it gives him a chance to "feel" better. Since the term time-out has so many negative associations, you might ask your child to rename it, something like cooling-off spot or feel-good place.

For very young children, try taking a time-out together in a place that encourages calm and quiet. It may include cushions, a favorite stuffy, or a book to read.
— Jane Nelsen

Grounding

The term grounding may make you think of teenagers forced to stay home for breaking curfew. But this technique — really a form of losing privileges — is also used by parents of young children, who say they learned it from their own parents. "When my 3-year-old son talks back or is defiant, we'll sometimes say, 'We're not going to the park if you keep acting this way,'" says one mom.

Another mom, who endured groundings herself growing up, says, "When my son was 6, he was grounded for throwing rocks over the school fence onto parked cars. He didn't like it, I don't think I ever did either as a kid. But I never repeated the offense, and, to my knowledge, neither has he."

What the experts say...

Keep it Like losing privileges, groundings work if the child misses something he cares about — otherwise it's worthless. For grade-schooler groundings — which generally last one day — require your child to stay home and miss everything other than school, church, or any commitment where her absence would let others down (such as a swim meet or dance performance).

For a serious offense, many parents also pull all home privileges, such as TV, video games, and computer time. It's a waste of time grounding a 2- or 3-year-old, as they really don't understand the connection.
— Michele Borba

Keep it Most parents choose a grounding period that's too long. Extended periods can backfire, causing your child to feel persecuted or picked on and starting a negative retaliation cycle. You want to keep hope alive.

To give a child strong incentive to behave immediately, try this: Your 6-year-old has been restricted for six days. For each good day, a day of restriction is dropped from the end. (Clearly define what good day means: Do what you're asked to do. Speak in a pleasant tone. Be kind and polite to your sister.) You may want to draw a chart or mark the duration on a calendar so your child can cross off days and see his progress.

Keep in mind that you don't want a grounding to make everyone else in the family miserable, and if the grounding isn't realistically enforceable, it will be more difficult for you to follow through consistently.
— Sal Severe

Toss it Grounding has no place in a positive discipline approach to raising a child. Children don't have to suffer to learn. Grounding is a form of punishment where adults do something to a child. Instead, think about ways to solve a discipline problem with your child.

If your kids are constantly fighting, instead of grounding them, you might, after a cooling-off period alone in separate rooms, have them focus on ways to resolve the problem — taking turns, removing the object in dispute, or putting the issue on the family-meeting agenda. Unless safety is a concern, don't get involved or take sides, and have faith they can work it out.
— Jane Nelsen

Yelling

If you grew up in a house of screamers, chances are you turn up the volume on your kids too. And that describes most of us: 98 percent of 7-year-olds have been shouted at by their parents, according to the Family Research Lab at the University of New Hampshire.

While no one is suggesting that the occasional angry outburst is damaging for life, there's evidence to suggest that constant yelling is as emotionally harmful to children as physical abuse.

So why do we bellow instead of staying mellow? We yell because we can, because we feel our children don't listen, because we're angry and lack other tools to call on in the moment, says Devra Renner, coauthor of Mommy Guilt, which calls yelling the number one guilt-inducer in moms of school-age children.

"A growing frustration is not being heard because our families are affixed to a screen of some sort," says Renner. "Parents are more inclined to yell if they're trying to talk to a distracted, screen-gazing kid."

What the experts say...

Toss it If you resort to yelling on a regular basis, you've created a cycle that's a trap. Your kids will wait for the yelling to make sure you mean business. Yelling actually reduces your influence by pushing you to more emotional intensity than the situation warrants — say, trying to convince your child to pick up his toys. It empowers your child: He knows he can upset you by delaying. It's self-defeating.

Instead, be relentless but not emotional. If you find yourself about to yell, take a break or have your partner step in. Backing off to cool off doesn't mean you're giving up for good.
— Carl Pickhardt

Toss it Upping the volume isn't the way to get what you want. Worse yet, the more frequent the yelling, the more often it has to be used to do the job. Your kid builds up a tolerance for yelling, so your pitch has to get louder, the frequency longer — and soon everyone is yelling just to be heard.
— Michele Borba

Toss it A raised, irritated, or angry voice sends the wrong message — loss of control. That's when kids are most likely to test you, because they realize you're hooked and beginning to dance. Instead, your tone should convey that you're firm, in control, respectful, and resolute. State your expectations in a matter-of-fact way with your regular speaking voice.

Your actions will convey your message more powerfully than words spoken loudly, so be prepared to take action immediately if your child continues to misbehave. Instead of hollering "turn the TV off" for the third time, simply switch it off yourself.
— Robert MacKenzie, the Setting Limits series

Forcing an apology

You want your child to be polite, but does a grudgingly muttered "sorry" really help? Or does it just serve to shame and embarrass your child in public? Still, who among us wasn't prodded into apologies for sparring with siblings, insulting friends, and being just a little too honest about that boring gift from Grandma? If you've spent any time hanging out near a sandbox lately, you know that the forced apology is still much mumbled on playgrounds nationwide.

What the experts say...

Toss it A forced apology isn't appropriate at any age. All a parent is doing is teaching a child to lie. If a child isn't sorry but a parent forces him to apologize, that's just about making a parent feel better — it has nothing to do with a child learning empathy.

Instead, parents need to help a child make a connection before a correction. First ask, "What happened?" Then, "How do you think Sammy felt when you took his toy away?" Once the child has had a chance to consider the consequences of his actions and empathize with the other person, follow up with, "What could you say to make him feel better?" You want the idea to come from the child.
— Jane Nelsen

Toss it Forcing an apology is like begging for a compliment. Both are worthless unless sincerely given. Sincere apologies are important because at issue are two vital parts of discipline: conscience and self-correction. Apologies need to be modeled for a child to learn to express genuine remorse. Parents who refuse to admit wrongdoing encourage children to follow that example.

Try setting this example with your child instead: "I'm sorry for what I said and if it hurt your feelings. My anger is no excuse. I won't say it again."
— Carl Pickhardt

Toss it With a forced apology, genuine sentiment is lacking and the lesson is lost. Plus, some kids may have a hard time offering a true apology verbally. But they can write a note, do a drawing, or make a small gift, all acceptable ways to handle a situation that requires an apology.
— Michele Borba

Put-downs

If a parent finds herself resorting to ridicule, guilt, shame, and humiliation, she likely picked up the habit from her parents. "I find myself using phrases like 'What's wrong with you?' and 'Why can't you act like other children?'" says one mom who heard similar comments growing up. "I'm sure this does nothing for my son's self-esteem — it just makes him angry and aggressive. I know that's how I felt."

Name-calling, belittling, and insulting ("You're such a bad boy"), scapegoating and blaming ("If you weren't so clumsy, the vase wouldn't have broken"), and sarcasm ("Now that was clever," delivered in a mocking tone) only scare or scar a child, say parenting authorities, who cite an array of problems linked to negative verbal interactions, including poor self-esteem, lack of self-control, impulsiveness, anger management issues, impatience, inability to trust, anxiety, depression, and emotional trauma.

What the experts say...

Toss it A national survey found that the average parent makes 18 critical, negative comments to his child for every one positive comment. As the old song goes, "You have to accentuate the positive to eliminate the negative." Look for ways to nurture your child's best qualities.
— Michele Borba

Toss it Parents who use put-downs, teasing, ridicule, and criticism do enormous damage to a child's self-esteem. These tactics are also self-defeating: Any corrective behavior is far outweighed by the cost of compliance. Parents who lash out verbally often can't see the injury they're causing but only care about only the obedience they're getting and the anger they're expressing. For punishment to work, it needs to be rationally thought out, not emotionally driven.
— Carl Pickhardt

Toss it Messages that shame, blame, criticize, or humiliate go too far. They reject the child along with the misbehavior. If you want your 5-year-old to stop poking her brother at the dinner table, a clear message would be "Keep your hands off your brother, please," or "Stop poking your brother." Not "Why do you have to be such a pest?"

Stanford Convocation speech BY Steve Jobs’05

yasimk@gmail.com (Yasim) — Tue, 26 Aug 2008 03:01:00 +0000

I am honored to be with you today at your commencement from one of the finest universities in the world. I never graduated from college. Truth be told, this is the closest I’ve ever gotten to a college graduation. Today I want to tell you three stories from my life. That’s it. No big deal. Just three stories.

The first story is about connecting the dots.
I dropped out of Reed College after the first 6 months, but then stayed around as a drop-in for another 18 months or so before I really quit. So why did I drop out?
It started before I was born. My biological mother was a young, unwed college graduate student, and she decided to put me up for adoption. She felt very strongly that I should be adopted by college graduates, so everything was all set for me to be adopted at birth by a lawyer and his wife. Except that when I popped out they decided at the last minute that they really wanted a girl. So my parents, who were on a waiting list, got a call in the middle of the night asking: “We have an unexpected baby boy; do you want him?” They said: “Of course.” My biological mother later found out that my mother had never graduated from college and that my father had never graduated from high school. She refused to sign the final adoption papers. She only relented a few months later when my parents promised that I would someday go to college.

And 17 years later I did go to college. But I naively chose a college that was almost as expensive as Stanford, and all of my working-class parents’ savings were being spent on my college tuition. After six months, I couldn’t see the value in it. I had no idea what I wanted to do with my life and no idea how college was going to help me figure it out. And here I was spending all of the money my parents had saved their entire life. So I decided to drop out and trust that it would all work out OK. It was pretty scary at the time, but looking back it was one of the best decisions I ever made. The minute I dropped out I could stop taking the required classes that didn’t interest me, and begin dropping in on the ones that looked interesting. It wasn’t all romantic. I didn’t have a dorm room, so I slept on the floor in friends’ rooms, I returned coke bottles for the 5¢ deposits to buy food with, and I would walk the 7 miles across town every Sunday night to get one good meal a week at the Hare Krishna temple. I loved it. And much of what I stumbled into by following my curiosity and intuition turned out to be priceless later on. Let me give you one example:

Reed College at that time offered perhaps the best calligraphy instruction in the country. Throughout the campus every poster, every label on every drawer, was beautifully hand calligraphed. Because I had dropped out and didn’t have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can’t capture, and I found it fascinating.

None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts. And since Windows just copied the Mac, its likely that no personal computer would have them. If I had never dropped out, I would have never dropped in on this calligraphy class, and personal computers might not have the wonderful typography that they do. Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later.

Again, you can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.
My second story is about love and loss.
I was lucky — I found what I loved to do early in life. Woz and I started Apple in my parents garage when I was 20. We worked hard, and in 10 years Apple had grown from just the two of us in a garage into a $2 billion company with over 4000 employees. We had just released our finest creation — the Macintosh — a year earlier, and I had just turned 30. And then I got fired. How can you get fired from a company you started? Well, as Apple grew we hired someone who I thought was very talented to run the company with me, and for the first year or so things went well. But then our visions of the future began to diverge and eventually we had a falling out. When we did, our Board of Directors sided with him. So at 30 I was out. And very publicly out. What had been the focus of my entire adult life was gone, and it was devastating.

I really didn’t know what to do for a few months. I felt that I had let the previous generation of entrepreneurs down - that I had dropped the baton as it was being passed to me. I met with David Packard and Bob Noyce and tried to apologize for screwing up so badly. I was a very public failure, and I even thought about running away from the valley. But something slowly began to dawn on me — I still loved what I did. The turn of events at Apple had not changed that one bit. I had been rejected, but I was still in love. And so I decided to start over.

I didn’t see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.

During the next five years, I started a company named NeXT, another company named Pixar, and fell in love with an amazing woman who would become my wife. Pixar went on to create the worlds first computer animated feature film, Toy Story, and is now the most successful animation studio in the world. In a remarkable turn of events, Apple bought NeXT, I returned to Apple, and the technology we developed at NeXT is at the heart of Apple’s current renaissance. And Laurene and I have a wonderful family together.I’m pretty sure none of this would have happened if I hadn’t been fired from Apple. It was awful tasting medicine, but I guess the patient needed it. Sometimes life hits you in the head with a brick. Don’t lose faith. I’m convinced that the only thing that kept me going was that I loved what I did. You’ve got to find what you love. And that is as true for your work as it is for your lovers. Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.
My third story is about death.
When I was 17, I read a quote that went something like: “If you live each day as if it was your last, someday you’ll most certainly be right.” It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: “If today were the last day of my life, would I want to do what I am about to do today?” And whenever the answer has been “No” for too many days in a row, I know I need to change something.Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.About a year ago I was diagnosed with cancer. I had a scan at 7:30 in the morning, and it clearly showed a tumor on my pancreas. I didn’t even know what a pancreas was. The doctors told me this was almost certainly a type of cancer that is incurable, and that I should expect to live no longer than three to six months. My doctor advised me to go home and get my affairs in order, which is doctor’s code for prepare to die. It means to try to tell your kids everything you thought you’d have the next 10 years to tell them in just a few months. It means to make sure everything is buttoned up so that it will be as easy as possible for your family. It means to say your goodbyes.

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of pancreatic cancer that is curable with surgery. I had the surgery and I’m fine now.

This was the closest I’ve been to facing death, and I hope its the closest I get for a few more decades. Having lived through it, I can now say this to you with a bit more certainty than when death was a useful but purely intellectual concept:

No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma — which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

When I was young, there was an amazing publication called The Whole Earth Catalog, which was one of the bibles of my generation. It was created by a fellow named Stewart Brand not far from here in Menlo Park, and he brought it to life with his poetic touch. This was in the late 1960’s, before personal computers and desktop publishing, so it was all made with typewriters, scissors, and polaroid cameras. It was sort of like Google in paperback form, 35 years before Google came along: it was idealistic, and overflowing with neat tools and great notions.

Stewart and his team put out several issues of The Whole Earth Catalog, and then when it had run its course, they put out a final issue. It was the mid-1970s, and I was your age. On the back cover of their final issue was a photograph of an early morning country road, the kind you might find yourself hitchhiking on if you were so adventurous. Beneath it were the words: “Stay Hungry. Stay Foolish.” It was their farewell message as they signed off. Stay Hungry. Stay Foolish. And I have always wished that for myself. And now, as you graduate to begin anew, I wish that for you.

Stay Hungry. Stay Foolish.

Azim Premji / Nandan Nilekani Interview

yasimk@gmail.com (Yasim) — Tue, 26 Aug 2008 02:50:00 +0000

Preschool director/teacher interview sheet

yasimk@gmail.com (Yasim) — Mon, 25 Aug 2008 16:17:00 +0000

Name: ________________________________________

Daycare center: __________________________________________

Address: __________________________________________

Phone: ___________________________________

Start looking for a good preschool before you need one. Parents who wait too long often discover that the school they think is best is already too full to admit their child. Visits can be as short as 15 minutes and as long as an hour — the more time you can spend, the better. Use these questions to guide your search.

Be sure to click on "printable version" in the yellow box at the top of the page to get a clean, easy-to-use copy of this interview sheet to take with you.

|Basics: A good preschool has solid, up-to-date credentials, clear rules and regulations, and firm policies on operating hours, pickup and drop-off times, and when children are too sick to attend.

1. About the school

* How long has the preschool been in business? _________________

* What are the school's accreditations?__________________________

2. Enrollment

* What is the school's licensed capacity? _________________

* Do you have space for my child? yes / no

If not, can we get on a waiting list, and how long is it?

_______________________________________________________

* Does my child have to be potty-trained to attend? yes / no

* Can I bring my child in for a pre-enrollment visit? yes / no

3. Days and hours

* What are your hours? _________________________________________

* What's your holiday schedule? ____________________________________

* On what other days is the preschool closed? __________________________

* How flexible are you with pickup and drop-off times?

_______________________________________________________

4. Costs

* What are the fees? ____________________________________________

* Do you offer scholarships or sibling discounts? yes / no

* Is there a late-pickup fee? yes / no

* Do I pay when we're on vacation? yes / no

* How and when would you bill us? ___________________________________

5. Interacting with parents

* Do you encourage visits from parents? yes / no

* What do you expect from me as a parent?

_______________________________________________________

_______________________________________________________

* How do you communicate with parents? Is there a regular newsletter, or a notice boatd? Is there a daily report or other process for informing parents of what children did during the day (naps, BMs, snacks, etc.)?

_______________________________________________________

_______________________________________________________

* Do you encourage parent/provider conferences? yes / no

|Size: Look for a preschool with small groups of children and plenty of staff. The National Association for the Education of Young Children recommends having at least one caregiver for every five to seven children ages 2 to 3, and 1:8 to 1:10 for 4- and 5-year-olds.

1. How are the kids grouped? mixed ages / grouped by age

2. How large is the group my child would be in? _________________

3. What's the teacher-child ratio in each group?__________________

|Staff: Employees should be educated, with at least two years of college, a background in early childhood development (although many states don't require this), and CPR and other emergency training. Caregivers should be responsible, enthusiastic, and well prepared, sharing your philosophies on key childrearing issues such as sleep, discipline, and feeding. A preschool with good staff benefits is likely to have less teacher turnover, which means consistent care for your child.

1. Staff and qualifications

* How many full-time teachers do you have? How many assistants?

_______________________________________________________

* What are the staff's credentials and training?

_______________________________________________________

_______________________________________________________

* Does the staff have emergency training?
CPR: yes / no
First aid: yes / no

* How do you screen staff? Do you perform background checks before hiring?

_______________________________________________________

_______________________________________________________

2. Staff compensation and work environment

* Do members of your staff get benefits like health insurance and paid holidays? yes / no

* Do they get breaks during the day? yes / no

* How long do staff members stay at the school, on average? _________________

|Philosophy: Be sure the preschool you're considering suits your personal philosophy. Think about, for example, whether you want a religious preschool, or one based on Montessori, Waldorf, Reggio Emilia, or another educational philosophy.

1. What is the school's educational philosophy?

_______________________________________________________

_______________________________________________________

2. Is the program developmentally based or does it have an academic focus? What's the advantage of your approach?

_______________________________________________________

_______________________________________________________

3. Do the children learn letters, numbers, and colors? yes / no

4. Will you be able to help me determine whether my child will be ready for kindergarten at the appropriate time? yes / no

|Activities: A good preschool will have a well-thought-out curriculum with a variety of activities. The program should be changed regularly so children have a chance to learn new skills and don't get bored. Television and videos should play little or no part in the day's schedule.

1. Are your toys and activities age-appropriate? yes / no

2. Do you have a safe, enclosed outside play area that encourages large-motor skills (climbing, running, riding wheeled toys)? yes / no

3. Do you have inviting and well-defined areas for different kinds of activities (art, music, blocks and toys, quiet reading, etc.)? yes / no

4. What will my child be doing on any given day? May I see the class daily schedule/routine?

_______________________________________________________

_______________________________________________________

5. What about extracurricular activities (dance, music, storytelling from an outside provider)?

_______________________________________________________

_______________________________________________________

6. Do you have field trips? If so, do you provide safe transportation?

_______________________________________________________

7. What role, if any, does television have at the preschool?

_______________________________________________________

|Social Skills: A good preschool program teaches children to take care of themselves and to respect other children and adults. Providers should help children learn how to express themselves appropriately, discipline them kindly, and encourage their good behavior.

1. How do you discipline children?

_______________________________________________________

_______________________________________________________

2. How do you comfort children?

_______________________________________________________

_______________________________________________________

3. How do you handle teasing, bullying, and inappropriate group behavior among the children?

_______________________________________________________

_______________________________________________________

|Health, Hygiene, and Safety: A good preschool is clean and sanitary and observes basic safety rules. If you see poorly maintained equipment or the preschool seems dingy or cramped, keep looking.

1. Health

* Must children be immunized in order to attend? yes / no

* What is your sick-child policy?

_______________________________________________________

_______________________________________________________

* What if my child needs medication during the day?

_______________________________________________________

_______________________________________________________

2. Hygiene

* Do caregivers wash their hands before feeding the children? yes / no

* Are children taught/required to wash their hands after using the potty? yes / no

* How often are the toys cleaned and replaced?

_______________________________________________________

3. Safety

* How old is your play equipment? When was it last inspected?

_______________________________________________________

* Are the children ever left unattended? yes / no

* Do you have a sign-in and sign-out sheet? Are the doors secure so strangers can't just walk in? yes / no

* What is your release policy? Who may pick up my child?

_______________________________________________________

* What is your disaster plan? Do you have procedures for handling fires, earthquakes, intruders, and other emergencies? Is the staff well trained for these situations?

_______________________________________________________

_______________________________________________________

|Food and Sleep: If the preschool provides food, make sure it serves nutritious meals (covering all four food groups) and snacks. Nap areas should be clean and quiet.

1. Eating

* Do you provide breakfast, lunch, and/or snack? yes / no

* If yes, what kind? _______________________________________________________

* If not, what kind of food should I bring for my child? Are there any food restrictions?

_______________________________________________________

2. Nap times

* Are children required to sleep, and if so, for how long?

_______________________________________________________

* What is the nap schedule?

_______________________________________________________

* Where do the children sleep?

_______________________________________________________

|Additional considerations: Be sure to take a moment to ask yourself the following questions when you visit.

1. Do the staff and children seem happy and engaged? yes / no

2. Do caregivers talk directly to the children? Is their tone friendly and caring? yes / no

3. Is the preschool clean and pleasant? yes / no

4. Is the bathroom a pleasant setting, encouraging children to use it? yes / no

5. Are appropriate safety measures (fire extinguisher, first aid kit, fences, etc.) in place? yes / no

6. During the hours you and your child are apart, will you feel at ease knowing your child is in this setting? yes / no

|References: Ask each preschool you're considering for a list of past and present references — and call them. Ask specific questions: Instead of asking whether they like the preschool, ask what exactly they do and don't like about it. If their child is no longer there, ask why.

Can you give me the names of some families I could call for references?

Name _______________________ Phone # _____________________

Name _______________________ Phone #______________________

Randy Pausch Last Lecture: Achieving Your Childhood Dreams

yasimk@gmail.com (Yasim) — Mon, 28 Jul 2008 02:48:00 +0000

Bharti Group chairman Sunil Mittal's Speech

yasimk@gmail.com (Yasim) — Wed, 16 Jul 2008 03:28:00 +0000

The respectful child: How to teach respect

yasimk@gmail.com (Yasim) — Mon, 09 Jun 2008 11:47:00 +0000

The respectful child: How to teach respect

by Mary VanClay

Highlights

What to expect at this age
What you can do

What to expect at this age

Trying to get respectful behavior out of a 2-year-old is like trying to get blood from the proverbial stone. That's due, in part, to the fact that a 2-year-old's language skills are still developing. So when you tell him it's bedtime, he can't say, "Gee, I'm really having fun with my trucks, and I wonder if we could negotiate for five more minutes of playtime?" He's more likely to ignore you, stick out his tongue, or yell, "I hate you!" at the top of his lungs. This doesn't mean he's a lost cause — only that he's very young and still needs years of consistent teaching and practice to learn how to show respect.

What you can do

Demonstrate respectful behavior. "We don't generally give our children the kind of respect that we demand from them," says Jerry Wyckoff, a psychologist and the coauthor of Twenty Teachable Virtues. "We get confused because often, our upbringing makes us equate respect with fear. 'I really respected my father because I knew he'd hit me if ...' That's not respect — that's fear." Instead, begin by listening. It can be hard to wait patiently for a 2-year-old to have his say, but it's worth it. Get down on his level, look him in the eye, and let him know you're interested in what he's telling you. It's the best way to teach him to listen to you just as carefully.

Teach polite responses. Your child can show caring and respect for others through good manners. As soon as he can communicate verbally, he can learn to say "please" and "thank you." Explain that you'd rather help him when he's polite to you, and that you don't like it when he orders you around. Again, being respectful yourself works better than lecturing. Say "please" and "thank you" regularly to your 2-year-old (and others), and he'll learn that the phrases are part of normal communication, both within your family and in public.

Avoid overreacting. If your child hits you or calls you a "doo-doo head," try not to get upset (after all, you know you're not a doo-doo head). A child who wants to provoke a reaction will endure almost any unpleasantness just to get a rise out of you. Instead, get face to face and say quietly but firmly, "We don't hit or talk that way in this family." Then show him how to get what he wants in a respectful manner: "When you want me to play with you, just ask me nicely. Say, 'Mommy, I want you to come read me a story right now.'"

Expect disagreements. Life would be much easier if our kids always happily complied with our requests, but that's not human nature. Try to remember that when your child won't do your bidding, he isn't trying to be disrespectful — he just has a different opinion.

Teach him that he'll fare better if he can learn to stop expressing himself disrespectfully ("You never take me to the park, you bad mommy!") and instead learns to put a positive spin on his requests ("Can we please go to the park after the grocery store?"). As your child's verbal skills mature, he'll be able to come up with these polite requests himself; in the meantime, teach him by supplying him with examples.

Set limits. "One of the best ways to demonstrate respect is to be both kind and firm in your discipline," says Jane Nelsen, an education specialist and the coauthor of Positive Discipline for Preschoolers. "Being kind shows respect for your child, and being firm shows respect for what needs to be done." So if your 2-year-old throws a fit in the supermarket, and none of your coping tactics work, what do you do? "Kindly but firmly take him out to the car, and sit and read a magazine until he's done," advises Nelsen. Then you can say calmly, "Now you're ready to try again," and return to the store. Eventually, he'll learn that a temper tantrum doesn't change the fact that the food shopping has to get done.

Praise respectful behavior. Reinforce your 2-year-old's impromptu displays of politeness as much as possible. But be specific. "The praise should describe the behavior in detail," Wyckoff emphasizes. "We tend to say, 'good girl,' 'good boy,' 'good job.'" Instead, say, "Thank you for saying please when you asked for a treat," or "Thank you for waiting your turn while the other kids got their ice cream." Be explicit, and your child will see that his efforts are worthwhile and appreciated.

Discover the Work You Were Born to Do

yasimk@gmail.com (Yasim) — Thu, 01 May 2008 00:50:00 +0000

So you've been hearing that voice again, the one that says you're not doing what you were born to do. That may be true, but how do you figure out what you should be doing?

To begin answering this question, examine whether your current career path matches your core interests, beliefs, values, needs and skills. Professional career counselors usually undertake this strategy when attempting to help clients identify appropriate career directions.

Here's what I ask clients to help them find their core. Ask yourself these questions, and record your answers:

1. What subjects do you most enjoy reading about?
2. What television or radio programs do you most enjoy?
3. What are your favorite types of movies?
4. What are your favorite hobbies or pastimes?
5. What type of volunteer activities do you prefer?
6. What subjects do you enjoy discussing with friends?
7. What subjects come to mind when you daydream?
8. What have been your favorite jobs?
9. What were your favorite school subjects?
10. What are your pet peeves?
11. If you doodle, what do you often draw?
12. If you ran the world, what changes would you make?
13. If you won a million bucks, what would you do with it?
14. Who are your favorite kinds of people?
15. How would you like to be remembered after your death?
16. What are your favorite toys?
17. How would you describe your political beliefs?
18. Who do you most admire in life and why?
19. What tasks have brought you the most success?
20. What tasks do you think you could do well that you haven't yet done?

Examine your answers. Do you see a certain behavior or belief in more than one aspect of your life? What information do you see repeated that seems to reveal a behavior pattern? What are your long-lasting interests?

Using this information, paint a self-portrait by completing the following statements:

I am mainly interested in…
I believe most in…
I most value…
For a good life, I feel I need…
I can do the following well…

Now ask yourself if your current job helps you achieve these five statements. If it does, you're probably in the right career. Chances are, however, that the nagging voice means your current career is not satisfying your core features. If this is the case, then it's time to find a better fit.

Ten Mistakes to Avoid for Data Warehouse Project Managers

yasimk@gmail.com (Yasim) — Sun, 27 Apr 2008 04:11:00 +0000

By Larissa Moss - TDWI

FOREWORD

Most organizations treat project management as an administrative function. A project manager often “manages” multiple projects. However, a more accurate way to define a project manager would be to say that he or she “administers” multiple projects because he/she is rarely involved in any daily project activities. The project teams merely report to him/her.

Project managers, assuming that data warehouse projects are like any other project, are often surprised when their data warehouse project spins out of control. The requirements appear to be a “moving target;” the schedule keeps slipping; the source data is much dirtier than expected and is impacting the ETL team; the staff does not have the necessary skills and is not properly trained; communication between staff members takes too long; traditional roles and responsibilities, and how they are assigned, seem to result in too much rework; the traditional methodology does not seem to work; and so on.

Techniques that work on other projects do not work well on data warehouse projects. This booklet describes how to avoid 10 common mistakes made by data warehouse project managers.

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ABOUT THE AUTHOR

Larissa Moss, president of Method Focus Inc., specializes in data warehousing, business intelligence, information quality, data integration, project management, and spiral data warehouse methodologies. She presents and lectures at various conferences worldwide. She co-authored the books Data Warehouse Project Management, Impossible Data Warehouse Situations, Business Intelligence Roadmap, and Data Strategy. Her works have been published in trade journals, including DM Review, Teradata Magazine, and TDWI’s Business Intelligence Journal. Additionally, her white papers are available through the Cutter Consortium and NCR/Teradata. She can be reached at methodfocus@earthlink.net.

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1. Failing to Use a Methodology

Software development has become relatively lax over the past two decades, and the use of system development methodologies has become more of an exception rather than a rule. Project teams—as well as business users—seem to think that with all the new development tools available, system development is (or should be) trivial. They are often surprised to learn that project managers and project teams must consider approximately 920 tasks when developing a data warehouse. Who can remember 920 tasks? No one. But every one can look up 920 tasks in a methodology.

Having the right kind of methodology is important. It cannot be a traditional “waterfall” methodology because that type of methodology assumes you are building a stand-alone “final” product, which does not have to integrate with any other product and will not dramatically evolve or expand over time. Thus, a traditional methodology does not include cross-organizational business integration tasks. Since a data warehouse is an evolving environment with many databases and applications, it is important to design databases and processes for reuse whenever possible. This requires specific integration tasks that a data warehouse methodology must provide.

In addition, a data warehouse methodology must take into account that a data warehouse environment cannot be built all at once. In other words, the deliverable will not be a stand-alone “final” product, but will have to be expanded and enhanced over time. If a data warehouse is successful, then each release will most likely generate new requirements. Sometimes these requirements will be for a brand new data warehouse application, but many times they are simply an enhancement of an existing application. Periodically, these new requirements may even demand that new technology be evaluated and purchased. A data warehouse methodology provides appropriate tasks for all of these activities.

Another differentiating aspect of data warehouse projects is that you have to manage multiple sub-projects in parallel. One such sub-project is the development of the data warehouse application (e.g., reports, canned queries, or customized cubes for slicing and dicing). Then there is the ETL process, including data profiling, data transformations, and data cleansing in addition to source data extracting and target data loading. A third sub-project may be building and loading the metadata repository. And there may even be a data mining deliverable, requiring its own development track.

A data warehouse methodology includes tasks for all of these development activities, and recognizes that many of these activities can run simultaneously.

Since metadata is an important deliverable, it deserves special mention when discussing methodologies. Not only does a data warehouse methodology have to include tasks for gathering, storing, and delivering metadata to the business community, it must also provide tasks for either evaluating and installing a purchased metadata repository product, or designing and building one.

In an evolving and expanding data warehouse environment, where maximum reusability must be built into all deliverables, it is important to continuously review and improve the environment. That means reviewing old and new requirements against existing data warehouse databases and applications, and finding ways to reuse what has already been built. Such reviews may result in requirements for minor database design changes, or program changes to the ETL process, reports, queries, or other applications. The methodology must provide tasks for conducting such reviews and folding the resulting changes into the next data warehouse project.

Taking the many development steps into account (from business case assessment to post-implementation review) and considering that most data warehouse projects are composed of several sub-projects, it is easy to understand that there are hundreds of tasks to be considered. Naturally, not all tasks have to be executed on each project, but all tasks must be known to the project manager so that he/she can pick the right ones for each data warehouse release.

The role of a methodology is to provide a list of all possible tasks, their dependencies, the roles and responsibilities assigned to execute them, and the deliverables resulting from them. Not using a methodology almost guarantees that vital tasks will be dropped, requiring rework that could have been avoided.

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2. Ineffective Project Team Structure

Traditional project teams are not structured to cope effectively with the dynamic nature of data warehouse projects and cannot react fast enough to the constant changes and challenges. What’s a traditional project team structure? Typically, the project manager alone defines and plans the project, and assigns a discrete set of tasks to each project team member. When a team member completes a task, the deliverable gets “handed over the cubicle wall” to the next team member who performs his/her assigned tasks and hands over the deliverable to the next person, and so on. Then on Friday afternoon, all team members submit a status report of their individually assigned tasks to the project manager who uses these reports to monitor and control the project activities. Occasionally, or regularly, team meetings are called to exchange information, and when a problem arises, special meetings are arranged with the business people or other stakeholders who can help resolve the issue.

A data warehouse team must be much more flexible and dynamic than that. There should be a core team of four to five people who together define, plan, and co-lead the project. The core team should be thought of as a high-powered, self-organizing SWAT team. Core team members must be 100 percent available from the beginning to the end of the data warehouse project. They brainstorm together, assign work to each other, review each other’s deliverables (peer reviews), resolve issues, and make project-related decisions together. This team should be staffed with senior-level team members who are experts in:

Project management (a lead person, not an administrator)
Subject matter expertise (a business representative, not an
IT person) (1)
Business analysis practices (data modeling and process modeling)
System analysis techniques (light programming)
Programming (ETL, OLAP, report writers, metadata repository, etc.)

Each person on the core team can be, and probably will be, assigned multiple roles. The core team roles and their main responsibilities are listed in the following table.

Core Team Role	Major Responsibilities
Application Lead Developer	Design and oversee the development of the data warehouse access and analysis applications.
Business Representative (2)	Make business decisions, resolve disputes between business units, and improve the source data quality.
Data Administrator	Perform cross-organizational data analysis, establish naming standards, create the project-specific logical data models and merge those models into an enterprise logical data model.
Database Expert (Architect and Administrator)	Design, load, monitor, and tune the data warehouse databases.
Data Quality Analyst	Assess source data quality and prepare data cleansing specifications for the ETL process.
ETL Lead Developer	Design and oversee the development of the ETL process.
Metadata Administrator	Build or buy, enhance, load, and maintain the metadata repository.
Project Manager	Define, plan, control, and review all project activities.
Subject Matter Expert	Provide business knowledge about data, processes, business rules, metadata, and requirements.
Technical Architect	Establish and maintain the technical infrastructure (hardware, network, middleware, system software).

(1) One-hundred percent availability from a business representative is a critical success factor for a data warehouse project. If management resists releasing one businessperson full time, it’s an indication that they don’t support the data warehouse as a critical strategic business initiative.

(2) The business representative role on the core team is usually assigned to the primary business user who represents the business units for which the data warehouse application is being developed. This person must be authorized to make business decisions on behalf of the business community he/she represents.

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3. Failing to Involve the Business People

Data warehouse projects are notoriously dynamic. That can be good or bad. Usually, it is perceived as bad because requirements change constantly; the scope is hard to control; the timeframes for delivering applications are unreasonably short; the data is usually dirtier than expected; business people are hard to pin down to provide business rules for data cleansing; project team members are often unclear about their specific roles and responsibilities, etc.

On the other hand, dynamic projects can be good because business people have an opportunity to learn about any new technology or tools early on. They also have an opportunity to “play” with their requirements and adjust them as they learn more about the capabilities and limitations of the data warehouse. IT folks can experiment with different database and application designs, and they can negotiate the project scope and delivery time to be more realistic depending on the difficulties they encounter. They can also profile the source data early and show all the data defects to the business people for resolution or deferment.

It should be obvious that dynamic projects have to be set up differently from traditional projects if the dynamics are to have a positive impact on the project team or the project schedule. The differences include adoption of a rapid development approach similar to prototyping, acceptance of the software release concept, a self-organizing SWAT team, and full-time involvement of business people in project activities. This is a paradigm shift for how applications are developed, and only a few business and IT people are comfortable with it. In contrast, organizations that successfully practice “extreme programming” techniques understand the benefits of this new approach because the prerequisites for extreme programming are the same (rapid development, software releases, SWAT teams, and participation from business people).

Why is it so important for business people to participate and what would they be doing on the projects? The most important reason business people should participate is to speed up the development work. It is a common complaint among IT people that situations come up several times a week for which they need input from the business people. But business people don’t often make themselves available. And when they do, it can be too late, especially when weeks have passed and IT has already assumed how best to resolve the situation. Sometimes IT guesses incorrectly, leading to rework, which can impact the project schedule. When combining these situations with changing business requirements that are not subjected to rigorous impact analysis, the result is a frustrated IT team and unhappy business users who don’t understand why IT takes so long to deliver the application. Business people must “live” the projects alongside IT in order for the entire project team to be more productive. Hence, business people must make time to become participating members of data warehouse project teams. They must participate in project planning, perform impact analysis on their own requirement (scope) changes, remove business-related road blocks (like data disputes between business areas), and perform other business-related project activities such as:

Determining project deliverables for each software release
Participating in tool evaluation and selection
Negotiating data and functional requirements
Participating in data and process modeling sessions
Providing data definitions and business rules
Participating in testing activities, including writing the
test cases
Profiling the source data and validating the quality of data
Identifying the cleansing rules for dirty source data
Validating/testing the accuracy of the ETL programs
Validating/testing the accuracy of reports and queries · Resolving disputes among business units
Monitoring/auditing the data warehouse data on an ongoing basis
Participating in post-implementation review discussions

Business people must be told that they are an invaluable and indispensable part of an effective data warehouse project team because they possess certain knowledge and authority their IT counterparts don’t have. In addition, business people understand the severity and monetary impact of their organization’s business problems, and they are the only ones with the position and authority to negotiate the priorities of data warehouse projects.

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4. Failing to Have Application Releases

The deliverable of a data warehouse project is usually a fully operable data warehouse application with a lot of functionality and a lot of data. The source data typically resides on multiple (and often heterogeneous) operational files or databases, which adds to the complexity of integrating the source data. The amount of data redundancy, data inconsistency, and data defects is habitually underestimated. Project teams who did not plan to spend the majority of their time on data cleansing are caught off guard—especially because they are expected to implement the fully functioning data warehouse application in an extremely short timeframe. In short, many project teams bite off much more than they can chew (i.e., their scope is much too large for their deadline).

It has been said for years that “you cannot build a whole data warehouse [environment] in one big bang.” Nobody challenges that anymore. But that does not go far enough in the attempt to reduce scope and complexity to a manageable chunk of work. Therefore, the new mantra should be: “you should not build a data warehouse application in one big bang.”

Following the principles of extreme programming, extreme project management, extreme methodologies, we should also adopt extreme scoping. Extreme scoping means reducing the complexity, and thus, the scope of each project in order to deliver something to the business users in a very short period of time. The first something would equate to only a fraction of the requested fully functioning application, but more functionality and more data would be added rapidly with each subsequent application release. Many business users still balk at this approach and insist on the “minimum required” deliverable, saying that anything less is of no use to them. They don’t realize that not only are they not losing anything, but they are gaining a lot with application releases.

Building an application in small iterations (application releases) will not take any longer than building the whole enchilada at one time. In addition, the business users can see their application grow and catch mistakes or adjust their requirements if needed (under strict change control procedures). This will greatly enhance the quality of the final fully functioning application. Another benefit of this approach is the opportunity for business people to slowly become familiar with their data warehouse application and any new technology or tools before the application is even completed.

Maybe the best way to illustrate the effectiveness of extreme scoping with application releases is to recall the concepts of prototyping. In prototyping we focus on a small (partial and incomplete) scope that is not too complex, and we produce a not yet fully functioning application. The next prototype release includes another small portion of the overall scope with a little more complexity and a little more functionality. This process can be repeated until the application is fully functioning. Although application releases are based on the same concepts as prototyping, they are not equal to prototyping. The difference is that traditional prototyping is pure ad hoc development, whereas application releases demand all necessary project activities to be performed with the rigor of a methodology.

Scoping data warehouse projects will remain a struggle as long as we are married to the idea that a project must produce a fully functioning application. But if we use application releases to build data warehouse applications, controlling the scope becomes much easier because the complexity of each release is reduced, the number of activities performed is decreased, and the project team can be smaller, rendering the methods for controlling the project more effective.

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5. Failing to Have an Active Project Charter

Most project managers create a short document that describes their project in terms of high-level requirements, users, schedule, resources, and budget. This document is often known as a document of understanding, project agreement, scope agreement, or project charter. Frequently, this document is created by copying an old document from a previous project and changing a few details here and there. Once the project is kicked off, this document disappears into a project manual—never to be seen again.

A well-thought-out project charter is a very useful instrument and should be used actively to monitor and control project activities during the entire development cycle of a data warehouse project. Therefore, the project manager and the business user, or business sponsor, should spend some time documenting the details of their agreement in this charter. While a detailed project charter can contain as many as 20 sections, the following four sections are the most useful to serve as a baseline for change control:

Scope
Risks
Assumptions
Constraints

Traditionally, scope has been measured by the number of functions the system will perform (function point analysis)—a sure way to underestimate effort, budget, and resources. Data warehouse applications are data-intensive, not function-intensive. Therefore, scope must be measured by the number of data elements that have to be extracted from the source systems, transformed and cleansed, and loaded into the data warehouse target databases.

Every project is subject to some risks—risks are unavoidable. Such risks could severely affect the project schedule as well as the project deliverables, depending on the likelihood the risks will materialize and the impact they would have on the data warehouse project. The project manager must identify triggers for each risk and incorporate a risk mitigation plan as well as a contingency plan into the project program.

An assumption is anything taken for granted; a supposition or a presumption. It’s important to document assumptions because a wrong assumption could very quickly turn into a risk. Important assumptions should always have counterpart risks, in case the assumptions either turn out to be false or do not materialize.

All projects are subject to the four constraints of scope, effort (time), budget, and resources (capable and available people). In reality, there is a fifth constraint: quality. Although quality is a measure of how well the deliverables meet the requirements, it can also be considered a constraint that must be balanced with the other constraints because higher quality requires more effort and therefore more time to deliver.

The project charter should record the agreed-upon scope negotiated under the stated risks, assumptions, and constraints. If any of these components change, the entire project has to be reevaluated and renegotiated, and the changes should be reflected in the revised project charter so it can be used as a baseline for the next change request.

Unfortunately, business managers and IT managers frequently put their project teams under unwarranted pressure to incorporate scope changes without ever referring back to the original agreement in the project charter, and also without performing the necessary impact analysis.

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6. Lack of a Readiness Assessment

Many project managers attend data warehouse conferences and learn best practices for planning, designing, and implementing data warehouses. But, when they return to their organizations and try to apply the best practices, they often encounter resistance from business users and “uninitiated” IT members. Regardless of how hard the project managers try to educate, convince, or force those who oppose them to follow best practices, they are often unsuccessful.

The mistake these project managers make is not realizing their organizations aren’t ready to suddenly stop building traditional stand-alone systems and begin building an integrated data warehouse environment. Some organizations are bent on trying every shortcut and silver-bullet solution before they admit those solutions only add to their data chaos.

Therefore, at the beginning of the initiative, an organization’s readiness should be assessed (understanding, ability, and willingness). A readiness assessment would include the following questions:

1. Have the goals and objectives been defined?
2. Do the goals and objectives for the data warehouse map to those
of the organization?
3. Has the source data been inventoried and modeled?
4. What is the quality of the source data?
5. Are the skills in place to build and support the data warehouse?
6. Is an adequate budget in place?
7. Has supporting software (ETL, cleansing, DBMS, etc.) been
selected and installed?
8. Is there a strong, well-placed, and reasonable business sponsor?
9. Does the business sponsor understand that a data warehouse is
not a stand-alone system?
10. Are the primary business users computer literate?
11. Are the business users’ expectations realistic?
12. Do the business users understand they have to participate in
project activities?
13. Does the business sponsor accept the approach of building
applications iteratively (using the software release concept)?

Based on the assessment, the project manager can determine which best practices to implement. Periodically, the questionnaire should be re-distributed to gauge the organization’s understanding of data warehousing. At that time, more best practices can be incorporated.

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7. Inadequate Testing

Data warehouse testing is often done poorly. It’s unacceptable—and so is the excuse that “it can be fixed in the next release.” If it takes too long to test the data warehouse application properly now, it will take even longer to test it later because the next release will be larger and more complicated.

The same types of testing activities that apply to operational systems also apply to data warehouse applications, including unit testing, integration (systems) testing, performance (stress) testing, quality assurance testing, and user acceptance testing.

Unit testing refers to the testing of discrete program modules and scripts. Every developer must test his or her program modules and scripts individually.

Integration testing tests the complete process. The interactions and flow of all programs must be observed and validated. Every time actual test results do not equal the expected test results, the program producing the error must be corrected, and all programs must be rerun.

The most complicated and time consuming type of testing is regression testing. The main goal of regression testing is to ensure any modifications to existing programs did not inadvertently produce errors.

Performance testing, also known as stress testing, is performed to predict system behavior and performance. Performance testing can be limited to only the most critical program modules with the highest volumes of data and the longest runtimes.

Most large organizations have strict procedures for moving applications into production. These procedures usually include QA testing, at which time the operations staff goes through a simulated production run before allowing the application to transfer to the production environment.

Acceptance testing is done by business users. They validate the functionality of the data warehouse application.

With the possible exceptions of unit and performance testing, all other testing activities are controlled by a test plan. The bulk of the plan will be a list of test cases. Each test case specifies the input criteria and the expected output results for each run. It also describes the program logic performed and the appearance of the resulting data.

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8. Underestimating Data Cleansing Efforts

Most organizations admit they are not paying sufficient attention to their data quality. As disheartening as the situation is with operational source systems, it is very discouraging to see that many IT and business managers are continuing to put pressure on project teams to build data warehouses quicker using the motto: “There’s never enough time to do it right, but always enough time to do it over.”

With project schedules shrinking and project scopes expanding, project managers are under the gun to deliver more in less time. Therefore, they habitually do not allocate enough time for source data analysis, business rule discovery, data cleansing, data reconciliation, and ETL testing. As a result, two things happen: (1) many data defects propagate into the data warehouse unnoticed, and (2) some dirty data is discovered too late when data exceptions are caught during ETL testing or while loading the data warehouse databases.

To avoid project delays, the project manager should build sufficient time into the project plan to profile each data element. Common data violations to look for include:

Missing data values
Default values that actually have a meaning, e.g., using
“888-88-8888” as a social security number to indicate
a non-resident alien
Logic embedded in a data value, such as an implied roll-up
structure, e.g., a 10-digit account number where the first four
digits are the branch number
Cryptic and overused data elements, e.g., using the values
“A, B, C, D” to mean type of customer, while the values
“E, F, G, H” mean type of location
Multipurpose data elements, e.g., data elements redefined using
the old COBOL “redefines” clause
Contradicting data values among dependent data elements, e.g., “Boston, CA” · Reused primary key, e.g., two different employees (one retired,
one active) with the same employee number
No unique primary key, e.g., one customer with multiple
customer numbers
Objects without their dependent parent object, e.g., job
assignments for employee 3321, but employee 3321 does not exist in the employee database

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9. Ignoring Metadata

Metadata is nothing new—it has always been a part of automated systems. It was found in system documentation, record layouts, database catalogs, and data declaration sections in programs. In fact, it used to be called the dirty “D” word—documentation. Since technicians detested the thought of doing documentation, they often simply didn’t do it.

However, in a data warehouse environment, metadata takes on a new level of importance. Since one data warehouse objective is to eliminate inconsistencies, data must be standardized. Standardization may result in renaming the data, splitting one source data element into multiple target columns, or populating one target column from multiple source data elements. It can also mean translating codes into mnemonics, standardizing (changing) data values, and filtering out inappropriate or invalid records. At the end of the day, business people will not be able to reconcile their operational source data to the data warehouse data unless they have the ability to trace these changes.

Therefore, metadata is now the nice “N” word—navigation. It helps the business people locate, manage, understand, and use the data in the data warehouse databases. It describes what data is available in which database, what it means, where it came from, how it was processed, how clean it is, and how it is used in reports and queries. Not delivering any metadata that could help business people navigate through their data warehouse environment is a mistake.

Granted, implementing a metadata repository has its challenges. Although many data warehouse experts consider metadata to be the “glue” holding the warehouse environment together, most organizations allocate little or no money for creating and maintaining a metadata repository. Also, metadata should be “living” documentation that is constantly updated, which means—at a minimum—one metadata administrator must be assigned full time to manage the metadata repository. But regardless of the challenges, metadata must be an integral part of a data warehouse environment.

And, since the importance of metadata is still not understood by most business executives, project managers need to do a much better job of promoting metadata and communicating its benefits to the business people.

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10. Being a Slave to Project Management Tools

Planning and controlling a project is not a trivial task. It takes a long time to create a work breakdown structure, estimate effort and duration time for all tasks, apply task dependencies and resource dependencies, and determine the critical path. Critical path refers to a string of dependent tasks that cannot be late without affecting the project schedule, as compared to other tasks executed at the same time with slack time built into them. For example, if it takes four days to evaluate a product but only three days to create a project charter (at the same time the product is being evaluated), then the task of evaluating a product is the critical path because it has no leeway in timing. If that task is a day late, the project schedule is impacted.

Knowing where the critical path tasks are at any point during a project is crucial to staying on track. Since estimates are only best guesses based on prior experience with similar tasks, the actual time it takes to complete a task usually differs from its estimate. These differences can easily change the critical path. Tracking the differences between estimated and actual time, and continuously adjusting the critical path has enslaved more than one project manager to his/her project management tool. Other project managers find this activity too laborious and too tedious, and they stop tracking the critical path altogether.

The best approach (and compromise) for tracking the critical path is to do it at the milestone level rather than at the task level because there are fewer milestones than there are tasks. Thus, it takes less time and effort to continuously adjust the project plan. The critical path among the tasks between the milestones can be tracked more informally using a whiteboard or a flipchart instead of the project management tool. This approach can be safely and effectively used when the scope of the data warehouse project is very small and the project team is managed by a self-organizing core team (SWAT team) rather than by
a project manager who is not involved in daily project activities.

Data Warehousing Battle of the Giants: Comparing the Basics of the Kimball and Inmon Models

yasimk@gmail.com (Yasim) — Sun, 27 Apr 2008 03:39:00 +0000

Data Warehousing Battle of the Giants: Comparing the Basics of the Kimball and Inmon Models

By Mary Breslin

Many organizations today need to create data warehouses-- massive data stores of time-series data used for decision support. These organizations face a range of choices, both in terms software tools and development approaches. Making good choices requires an understanding of the two main data warehousing models-- Inmon's and Kimball's.

Bill Inmon advocates a top-down development approach that adapts traditional relational database tools to the development needs of an enterprisewide data warehouse. From this enterprisewide data store, individual departmental databases are developed to serve most decision support needs.

Ralph Kimball, on the other hand, suggests a bottom-up approach that uses dimensional modeling, a data modeling approach unique to data warehousing. Rather than building a single enterprisewide database, Kimball suggests creating one database (or data mart) per major business process. Enterprisewide cohesion is accomplished by using another Kimball innovation, a data bus standard.

Understanding how these two models are similar and how they differ gives the reader a foundational knowledge of the most basic data warehouse concepts. We will also explore which organizational characteristics are best suited to each approach.

Introduction and Context
We begin our discussion by defining the data warehouse. We will introduce the Inmon-Kimball debate, and provide a brief history of the evolution of the two models. We also provide a brief explanation of the nature of the data warehouse, and conclude with a discussion of the scope of the article.

Context of the Inmon-Kimball Debate
A data warehouse contains massive amounts of highly detailed, time-series data used for decision support. Data warehouses often contain terabytes of data that can be readily queried by end users. The sources of most of the data in a data warehouse are internal transaction processing systems (also known as operational systems). Specialized software extracts data from operational databases, then summarizes, reconciles, and manipulates it. Then the data is ready to be stored in carefully designed relational database tables in the data warehouse.

An organization must choose a set of data warehouse design and maintenance tools from among scores of software tools commercially available. Not all tools are compatible with each other, and not all tools are appropriate for all development methodologies. Despite the array of choices, the industry's tools and methodologies are generally based on only two models: Inmon's and Kimball's.

Choosing between Inmon's, Kimball's, and a hybrid model is, at the most basic level, a choice of both architecture and methodology (Wells, 2003a). Understanding the basics of the architecture and methodology of both models provides a good foundational knowledge of data warehousing. Upon this foundation, readers can build situation-specific knowledge that is appropriate to their organization's needs.

History of the Data Warehouse
How did Inmon and Kimball come to be giants in this field? Each is a creator of a unique school of thought and practice within data warehousing.

In 1990, Bill Inmon earned the moniker "Father of Data Warehousing" by coining the term in his seminal work Building the Data Warehouse. The industry soon began to implement Inmon's vision, with varying degrees of success. In the third edition of this work (2002), Inmon describes a logical architecture that extracts detailed, time-stamped data from disparate operational databases. The data is then transformed and stored in a single database (the data warehouse). Data extracts from this monolithic data warehouse create smaller, departmental databases. Decision support users query and create reports from the departmental databases. To create both the data warehouse and the departmental databases, Inmon proposes a top-down variation of the spiral system development methodology.

After the publication of Inmon's book, other database experts began creating data warehouses. The experience of one scholar-practitioner, Ralph Kimball, led to the development of a model that competes with Inmon's. In 1996, Kimball first published his model in his seminal work, The Data Warehouse Toolkit. After several years of experimentation, he published a second edition in 2002. In the latest version, he recommends an architecture of multiple databases, called data marts, organized by business process. The sum of the data marts comprises the data warehouse. He recommends a development methodology that is unique to data warehousing. It involves a bottom-up approach that must adhere to an enterprisewide standard "data bus." (See "The Data Bus and Conformed Dimensions" later in this article for a discussion of the data bus).

Nature of the Data Warehouse
The data warehouse exists to facilitate decision support in the organization. Decision support systems help users with ad hoc analyses and strategic decision making. Generally, decision support systems require historical data, both summarized and at a transaction level of detail. Users need to be able to query these massive amounts of data easily. Often, they may not really know what relationships between data elements they are searching for. One data warehousing anecdote tells how a retail chain learned that new fathers often shopped for diapers and beer in the same trip. Sales of both products soared when the diapers and beer were placed next to one another. Data warehousing technology is credited with the discovery (Albert, 2000).

This example neatly illustrates the nature of data warehousing What does it take to find a statistically significant purchasing relationship between two such unlikely products? One obvious requirement is that the data you are analyzing must be sufficiently detailed to contain the date of the transaction as well as descriptions of the products purchased. This illustrates why data warehouses tend to contain very large quantities of time-stamped data.

A less obvious requirement of finding the beer-diaper connection is being able to "browse" through the warehouse without really knowing what you are looking for. In data warehousing, you typically submit many queries before you get results worth analyzing. This means data warehouses must make it reasonably easy for end users to make queries. This, in turn, implies user-friendly access tools and reasonable response times. When you consider user-friendly access of massive amounts of detailed data with reasonable response times, you can appreciate the challenges of providing an effective data warehouse solution.

Scope of This Article
This article compares and contrasts the Inmon and Kimball approaches to meeting the challenges of creating a data warehouse. While it discusses the most basic aspects of both approaches, there are many topics it does not address. For example, the article does not address physical design considerations, such as distributed data warehouse processing. It does not discuss special applications of the data warehouse, such as support of executive information needs, or considerations in creating Webbased data warehouses.

This article does not address some concepts that scholarpractitioners in the industry consider fairly basic, such as metadata, snowflaking, or data mining. These topics have been excluded from the article in order to give more thorough attention to the most basic aspects of each model.

The Inmon Model
Inmon's architected environment consists of all information systems and their databases throughout a given organization. He calls this behemoth the Corporate Information Factory, or CIF (Inmon and Imhoff, 2002). Even a cursory discussion of the CIF is beyond the scope of this article, and therefore the following discussion is limited to those components of Inmon's architected environment most essential to the data warehouse.

Inmon divides the overall database environment of the organization into four levels:<

Operational
Atomic data warehouse
Departmental
Individual

The last three levels comprise the data warehouse. The first level contains data from legacy and other transaction processing systems. This level supports the day-to-day operation of the organization; in other words, the first level supports all transaction processing. From the operational systems, data is extensively manipulated and then moved to the atomic data warehouse (Inmon, 2002). (See "Extract, Transform, and Load" later in this article for an overview of the data manipulation performed between the operational and atomic data warehouse levels.)

Inmon uses an example to illustrate the difference between operational data and data stored in the atomic data warehouse. In the example, the entity is a customer, and the attribute of most interest is the customer's credit rating. The operational system's database contains the customer's current credit rating and related information of interest (such as loan balances, address, etc.) in a single record. The atomic data warehouse, by contrast, contains the credit history for this customer, summarized by year, with one record per year (Inmon, 2002).

Inmon does not thoroughly pursue the customer credit example in its transformation from the atomic to the department level. His example is extended here based on a synthesis of various discussions throughout his book. The data contained in the departmental level is lightly to heavily summarized, depending on a given department's information requirements. The credit department might lightly summarize the data by dropping customer address information as irrelevant, but keeping a "flag" to indicate a change of address. In contrast, the marketing department might more heavily summarize the data by dropping all customer-identifying data except zip code. Each department's database can hold data summarized according to its needs. At the same time, Inmon's architecture ensures that all data is consistent because all departmental data comes from the atomic data warehouse.

Individual users create the fourth and final level of the architected environment when they create heuristic, ad hoc data sets as part of decision support analyses. This fourth level tends to be temporary and housed on the individual user's personal computer (Inmon, 2002). For example, a user working in the credit department might ask to see records for all accounts that have been delinquent at least once in the last three years.

If the department's database has not retained the data at the level of detail needed, it is possible to query the atomic data warehouse. Queries against the atomic data warehouse generally go through the IT department. Inmon argues that the atomic data warehouse is worth the initial effort to construct because it allows the creation of any number of departmental databases without risking creating incompatible data between them (Inmon, 2002). This is done using a three-level data model.

The Three-Level Data Model
Inmon proposes three levels of data modeling. The first is ERD (entity relationship diagrams). Just as in the development of operational databases, ERDs are used to explore and refine entities, their attributes, and the relationships between entities. The development team creates one set of ERDs for each department that is expected to use the data warehouse. The corporate ERD is the sum of all department ERDs (Inmon, 2002).

The second (mid-level) data model, establishes the DISdata item set) for each department. Again, the sum of the departmental DISs comprise the corporate DIS. The midlevel data model includes four constructs:

A primary data grouping
A secondary data grouping
A connector, signifying the relationships of data
"Type of " data

A critical aspect of the mid-level data model is that the primary grouping exists only once for each major subject area. This means that an ERD created in the first-level data model is the basis for a DIS in the second-level data model. Figure 1, taken from Inmon's book, illustrates the ERD-DIS relationship for a given user view. It also shows

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Figure 1. Relationship between Levels One and Two of Inmon's Data model (Inmom,2002)

Figure 1. Relationship between Levels One and Two of Inmon's Data Model (Inmon, 2002)

how the various user views are combined into a corporate ERD and DIS. Within a DIS, each rectangle represents a logical table in either a departmental or the corporate DIS. The connections between these tables are the same as those that connect entities in the ERDs. Rectangles to the right in a given DIS represent the secondary grouping of data (Inmon, 2002). ("Type of " data does not appear in Figure 1. It would be represented by another column of rectangles branching to the right from the secondary grouping rectangles.)

Inmon's banking example helps make this clear. In banking, the entity "customer" generates a primary grouping of data such as account (primary grouping). "Account" may have several manifestations, such as loan, savings, or trust (secondary grouping). Connectors show that one customer may have several different accounts. Finally, each account may have data generated by similar activities, such as ATM deposits, ATM withdrawals, teller deposits, or teller withdrawals; these are examples of "type of" data (Inmon, 2002).

Creating the departmental and corporate ERDs and DISs shown in Figure 1 requires very high levels of data modeling expertise. It also requires breadth and depth of knowledge of the organization's business processes. Inmon suggests using enterprisewide data models if possible to save development time; they already exist for many industries (Inmon, 2000).

The final level of Inmon's data model is the physical. In his words: "The physical model is created from the mid-level data model merely by extending the mid-level data model to include keys and physical characteristics of the model" (Inmon, 2002). Inmon explains various techniques for optimizing the performance of the data warehouse at both the atomic and departmental levels. Although the techniques may not be familiar (creating arrays of data, preformatting, rejoining tables), the purpose--optimizing I/O performance --is the same as for operational database systems. Most of these techniques involve denormalization of tables.

There are several reasons to denormalize tables at the physical level. For example, records in the atomic data warehouse are rarely updated because the data is historical. This makes it possible to physically place data in ways that would not work for operational data because it is frequently updated (Inmon, 2002).

Figure 2. Inmon's Meth2 (Inmon, 2002)

Figure 2. Inmon's Meth2 (Inmon, 2002)

Once the three-level data model is complete, the data warehouse development has begun.

A Spiral Development Approach (Meth2)
A completed three-level data model is the only prerequisite to using Inmon's special adaptation of the spiral development methodology, which he calls Meth2. (Meth1 is for developing operational systems; Meth3 is for tuning an existing data warehouse). Inmon calls the modeling step DSS1 (for Decision Support 1). He outlines nine more steps, shown in Figure 2.

Using the completed three-level data model as the first input to the process, the next step is to conduct a size/granularity analysis (DSS2 in Figure 2). Granularity is a measure of the detail of the data. For example, transactional data has the lowest level of granularity because it has the most detail. Inmon calls the size/granularity analysis a breadbox analysis, presumably an allusion to the saying: Is it bigger than a breadbox? If the volume of data is massive, then the team needs to consider multiple levels of granularity for the data (Inmon, 2002). This might involve storing some data at a transaction level and other data in summarized forms (such as a daily total).

Once granularity issues are resolved, the first subject area is selected (DSS5). This will become the first departmental database. The team analyzes the source systems of the first subject (DSS7), writes specs (DSS8), code programs (DSS9) and populates the database (DSS10). The atomic data warehouse database design begins concurrently (DSS6). When there is enough information to do so, the team conducts a technical assessment (DSS3). This assessment ensures that the data in the warehouse will be accessible and well managed (Inmon, 2002).

As the team develops each successive departmental database, they impact the atomic data warehouse. Figure 2 shows this iterative aspect of the model by showing lines connecting various steps. Lines connect both the source systems analysis step (DSS7) and the specs step (DSS8) with the atomic data warehouse design (DSS6). This means that the atomic data warehouse design will be revisited each time a new departmental database is developed. The line connecting the population of a departmental database (DSS10) with the preparation of the technical environment (DSS4) also shows the iterative nature of Meth2. By preparation of the technical environment (DSS4), Inmon means making sure that the data warehouses's network, storage hardware, OS, and all interface and access software are ready to receive data (Inmon, 2002).

Being data driven is an essential aspect of Inmon's spiral development methodology. "One of the salient aspects of a data-driven methodology is that it builds on previous efforts--utilizing both code and processes that have already been developed." (Inmon, 2002) His three-level data model helps support a spiral methodology, in that all user views are consistent with the corporate model. The team derives subsequent departmental databases using the code and processes they created when they developed earlier departmental databases. This means the time it takes to produce the second departmental database should be considerably less than the time it took to go through DSS1 through DSS10 for the first departmental database.

Inmon's Philosophy: Evolutionary, Not Revolutionary
Inmon sees the data warehouse as an integral part of the Corporate Information Factory (CIF). This means, among other things, that the data warehouse and operational databases are all part of a larger whole. This perception helps explain why Inmon's data warehouse must adhere to most of the same standards as operational systems. From this premise, it is easy to see how Inmon's evolutionary approach grows out of operational relational database technology and development methods. Each aspect discussed in this article--the architected environment, the three-level data model, and the spiral approach--is consistent with established practices in operational DBMS design and deployment. It is built upon principles and practices that have been in use in the operational database world at least a decade longer than even the earliest data warehouse efforts. Viewed in this context, Inmon's model is much more evolutionary than revolutionary.

A by-product of this evolutionary approach is that Inmon's primary audience is IT professionals, as it takes an IT professional's level of understanding to actively use his tools or development methodology. Inmon's tools and methodology ensure that end users will have mostly passive roles in the development of the data warehouse, reviewing the IT professionals' output.

Kimball's Model
Kimball's model differs in several important respects from a traditional relational database approach. One significant difference is that data warehouses built with the Kimball model use a data modeling method unique to the data warehouse. This is discussed in the next section: "Dimensional Data Modeling."

Another significant difference is that the overall architecture features multiple databases that are expected to be highly interoperable. The data bus is the main design feature that makes this possible (further discussion of the data bus is included in the section "The Data Bus and Conformed Dimensions").

Dimensional Data Modeling
Dimensional modeling may seem strange to IT professionals familiar with traditional relational modeling. Dimensional modeling begins with tables rather than entity-attribute data models such as ERDs. The tables are either fact tables or dimension tables. Fact tables contain metrics, while dimension tables contain attributes of the metrics in the fact tables. Dimension tables routinely contain repeating groups; this violates normalization rules. However, dimensional modeling violates normalization rules in order to achieve a high level of performance in the data warehouse, while keeping it end-user accessible.

An example best illustrates how dimensional modeling meets the dual objectives of ease of use and performance. The first example in Kimball's book is a retailing data warehouse (Kimball, 2002). One fact table from this example is the Daily Product Sales table. This table contains five columns: the product key, store key, date key, quantity sold, and dollar sales amount. The dimension tables in this example include the Date Dimension, Store Dimension, and Product Dimension tables.

Fact tables contain many rows and relatively few columns; this is essential to ease of use and query performance. The number of rows in Daily Product Sales table can be estimated using formulae. While explaining the formulae is beyond the scope of this article, they basically involve assumptions regarding the number of different products sold in each store each day. Kimball estimates that the Daily Product Sales fact table is likely to contain millions of rows, and be about 10 GB or more (Kimball, 2002). Although the table has only five columns, adding just one additional column would increase the file size by 2 GB! This example makes it easy to grasp the importance of keeping the number of columns in fact tables as small as possible.

In contrast, the dimension tables are likely to have only hundreds or thousands of rows (rather than millions), and be only megabytes in total size (Kimball, 2002). Unlike fact tables, dimension tables may have a hundred columns or more. This is because they contain all the attributes of the data in the fact table in highly denormalized forms. Following along with the retailing example, the primary key of the Product Dimension table is the product key. The rest of the dimension table's columns are attributes of product. These include product description, brand description, package type description, department description, package size, weight, shelf life, shelf width, shelf height, and many more. The Date Dimension and Store Dimension tables also have large numbers of columns, but relatively few rows.

It is easy for end users to query the database because virtually all the ways of summarizing the data is already in the dimension tables. This goes a long way toward meeting the ease of use goal. In terms of meeting the performance goal, Kimball says:

A database engine can make very strong assumptions about first constraining the heavily indexed dimension tables, and then attacking the fact table all at once with the Cartesian product of the dimension table keys satisfying the user's constraints.

Dimensional modeling is a data modeling approach that capitalizes on the unique requirements of the data warehouse. Keeping fact tables to a small number of rows and allowing dimension tables to be highly denormalized are both essential. The resulting data mart is highly accessible to the end user and provides reasonable query response times.

The Data Bus and Conformed Dimensions
In Kimball's architecture, data is copied from operational source systems to a staging area. In the staging area, the data is scrubbed, that is, made consistent and suitable for end-user queries. (The scrubbing process is discussed in "Extract, Transform, and Load" later in this article.) From the staging area, data is loaded into data marts. The data marts are the source of data for user queries.

Each data mart is based on a single business process. Some examples of business processes are point of sale (retail sales), inventory (from receiving dock to point of sale), procurement, and order management. More than one department may be interested in a given business process; therefore, no one department is perceived as the sole owner of a given data mart (Kimball, 2002).

The data warehouse bus is the part of Kimball's architecture that allows the sum of the data marts to truly be an integrated whole--a data warehouse. The bus architecture is another way of saying that all data marts must use standardized conformed dimensions. The basic requirements of conformed dimensions are that keys, column names, attribute definitions, and attribute values are consistent across business processes. Put another way, two dimensions are conformed "when they are exactly the same, or one is a perfect subset of the other. Most important, the row headers produced in answer sets from two different conformed dimensions must be able to be matched perfectly" (Kimball, 2002). This may seem an impossible set of requirements, but a knowledge of dimensional data modeling and adherence to the four-step dimensional design process help keep the requirements manageable.

An example of using conformed dimensions across business processes will help make clear how these requirements can be met without superhuman efforts. One data item that spans multiple business processes is the product dimension. The primary key for the product is an artificial key assigned during the ETL process. The first data mart development defines the product key, and all subsequently developed data marts must use the key. This ensures that queries can be made across data marts without conflicting results. For example, product 18874002 is the same to a user interested in patterns of the product's movement through the warehouse as it is to the user interested in the relative success of a promotion for the product. In other words, conformed dimensions help ensure that product data refers to the same product in the retail sales data mart as in the inventory data mart.

The Four-Step Dimensional Design Process
Kimball recommends a development methodology that is unique to data warehousing. It involves a bottom-up approach, which in the case of data warehouses means to build one data mart at a time. The four steps of the dimensional design process are:

Select the business process
Declare the grain
Choose the dimensions
Identify the facts

Kimball defines business processes quite broadly. Examples include point of sale (POS) retail sales, inventory, ordering, and shipments, all of which cross department lines in most organizations. For example, the ordering process is of interest to sales, marketing, finance, and inventory control personnel. To choose the first business process for the data warehouse project, select the process that has "the most impact--it should answer the most pressing business questions and be readily accessible for data extraction" (Kimball, 2002).

Declaring the grain is the process of deciding what level of detail the data warehouse will contain. The lowest level of granularity is called atomic, meaning that it cannot be further subdivided. Choosing a grain at the atomic level is highly desirable, since users can always aggregate the data as desired. Choosing a more summarized level means queries below that level cannot be fulfilled by the data warehouse. In Kimball's words:

Preferably you should develop dimensional models for the most atomic information captured by a business process... A data warehouse almost always demands data expressed at the lowest possible grain of each dimension. (Kimball, 2002)

In the retail example, the grain declared is an individual line item on a POS transaction. The possibilities for analyzing data with this level of granularity are virtually unlimited. It allows for the discovery of non-obvious relationships in retail sales, such as the beer-and-diaper relationship (as discussed previously). Atomic data granularity provides decision support for virtually every aspect of retail sales. Examples include evaluation of promotions, expansion or contraction of product lines, and cannibalization of the sales of one product due to the promotion of another.

With the grain declared, the next step is to choose dimensions. In the retail example, the dimensions include date, store, product, and promotion. Each of the dimension tables has a large number of attributes. The date dimension table includes many attributes that would make a relational data modeler shudder, including Day Number in Epoch, Week Number in Epoch, Month Number in Epoch, Day Number in Calendar Month, and so on. Kimball justifies this highly denormalized table by pointing out that ten years' worth of such data generates only approximately 3,650 rows and a file measured in kilobytes (Kimball, 2002).

The fourth and final step is to determine which facts to include in the fact tables. In the retail example, Kimball chooses to include some computed values as well as truly atomic values, making queries easy for the end user and providing acceptable data warehouse performance. The values in retail sales fact table are: Date, Product, Store, Promotion, POS transaction number, Sales quantity, Sales dollar amount, Cost dollar amount, and Gross profit dollar amount (Kimball, 2002). Including the gross profit dollar amount is an example of improving performance while violating traditional relational database rules. Users frequently query the data warehouse for gross profit. Therefore including this computed value in the fact table improves query performance.

The result of the four-step process is shown with minimal detail in Figure 3. Sample Kimball Fact and Dimension Tables. The fact table is shown with all the facts, but the dimension tables are shown only with their primary keys. Each of the dimension tables shown in the figure has dozens of dimensions. The wealth of dimensions allow end users to compose virtually unlimited queries.

Figure 3. Sample Kimball fact and dimension Tables (Kimball, 2002)

Figure 3. Sample Kimball Fact and Dimension Tables (Kimball, 2002)

Basics of Kimball's Data Warehouse Philosophy
Kimball's philosophy shines through every chapter of his book. The business requirements drive both the process and the nature of the data warehouse. In the first chapter, he defines the goals of a data warehouse (Kimball, 2002):

Make information easily accessible
Present the organization's information consistently
Be adaptive and resilient to change
Protect information
Serve as the foundation for improved decision making

He ends his list with a warning, masquerading as a goal: "The business community must accept the data warehouse if it is to be deemed successful" (Kimball, 2002). To Kimball, acceptance is measured by how much the data warehouse is used, which is directly related to its userfriendliness. This proactive stance in "designing in" userfriendliness is essential to Kimball's philosophy. Kimball's four-step development methodology is easy enough for the end user to actively participate. The example retail sales dimensional model (Figure 3) shows the user-friendly nature of the final form of the data mart. Both the attribute names and the relationships between the fact table and dimension tables are very familiar to users who need to query retail sales data.

Similarities and Differences: Inmon versus Kimball
Similarities
The most prominent similarities between Inmon's and Kmball's models are the use of time-stamped data, and the extract, transform, and load (ETL) process. Although the execution of these two elements differs between the two models, the data attributes and query results are very similar.

Similar Time-Stamped Data
Operational systems' databases generally carry detailed data for "anywhere from one week to two years" (Inmon, 2002). In contrast, the data warehouse stores data for five or even ten years. The time attribute is arguably the most important defining characteristic of data warehouse data. This is so because it is the time attribute that allows decision support analyses to compare this year's sales of Product X with last year's, or to determine whether more of Product X is sold on weekend than on holidays. So, how the time attribute is captured is critical, because it controls which analyses are possible and which aren't.

Figure 4. Kimball's Date Dimension (Kimball,2002)

Kimball calls the time attribute the "date dimension;" Inmon calls it the "time element." Figure 4. Kimball's ate Dimension shows a range of possibilities for time attributes for a retail sales data mart. In Kimball's example, the date key is an artificial key that defines a conformed dimension. In an Inmon example, the same attributes would either be contained in several different, more normalized tables or simply be calculated at the time of the user query. The choice of storing versus calculating in Inmon's model would be guided by performance considerations. Whether using an Inmon-or Kimball-based approach, however, end users are able to query the data by day, month, quarter, year, holiday, weekday, weekend, etc.

Similar Extract, Transform, and Load (ETL)
The data warehouse environment begins with (ETL). Data is extracted from operational databases, transformed to meet the data warehouse's standards, and loaded. The data is loaded into either the monolithic data warehouse Figure 4. Kimball's Date Dimension (Kimball, 2002)(· la Inmon) or into a series of smaller databases called data marts (· la Kimball).

The ETL process has spawned a market niche, and there are a number of ETL tools available today. Some are addons to DBMSs, such as the ETL tools Oracle provides. Others are DBMS-independent. Even a cursory comparison of ETL tools is beyond this scope of this article. Instead, we will discuss the general process and scope of the ETL activity and its importance to the data warehouse.

Extract: The first part of ETL--extract--involves moving data from operational systems to a persistent staging area. Issues of timing of the extraction can be important in the extract process, in that different systems may make a given data item available at different times. It is also important to know how the operational systems handle exceptions and updates, since once data enters the data warehouse, it is rarely subject to updating.

Transform: Once data is extracted into the staging area, it is ready for the transformation portion of ETL. A simple transform example is renaming a data item, such as when two different operational systems call a single data item by a different name. A more complex example is adjusting the value of a data item, such as when two different operational systems measure a product or process differently and therefore assign a different value to the same data item. In general, the purpose of the transform processes is to ensure data integrity within the data warehouse. There are several methods used to transform data, including field mapping and algorithmic comparisons.

Load: The final step in ETL is loading the data into either the atomic data warehouse (in Inmon's model) or into data marts (in Kimball's model). The load process in either case involves placing the data physically. The main concern in this process is appending the newly extracted and transformed data onto the data already in the data warehouse. Various ETL routines run at this point help ensure data integrity and guard against data redundancy.

ETL is essential to the viability of the data warehouse in that it attempts to ensure data integrity within the data
warehouse. Obviously, if two user queries that are essentially the same return two different results, the credibility
of the data warehouse is damaged in the eyes of the users. Because operational systems are seldom (if ever) designed
to produce results compatible with one another, making the output of these systems consistent is generally aHerculean effort. Not surprisingly, ETL is frequently considered the most labor-intensive data warehouse activity,
surpassing even decision support analysis activities!

Differences
The differences between Inmon's and Kimball's approaches are many and deep. It is interesting to note that the two features that create similarities between the two models--timestamped data and ETL--are required to make decision support systems viable. In other words, the two models are similar only in the areas in which, arguably, they have to be similar. In all other areas, their differences are profound. The most essential differences between the two models are in the areas of development methodologies, data modeling, and data warehouse architectures. Table 1 summarizes these differences. Following the table, each major area of difference is discussed in detail.

	Inmon	Kimball
Methodology and architecture
Overall approach	Top-down	Bottom-up
Architectural structure	Enterprisewide (atomic) data warehouse "feeds" departmental databases	Data marts model a single business process; enterprise consistency achieved through data bus and conformed dimensions
Complexity of the method	Quite complex	Fairly simple
Comparison with established development methodologies	Derived from the spiral methodology	Four-step process; a departure from RDBMS methods
Discussion of physical design	Fairly thorough	Fairly light
Data modeling
Data orientation	Subject- or data-driven	Process oriented
Tools	Traditional (ERDs, DISs)	Dimensional modeling; a departure from relational modeling
End-user accessibility	Low	High
Philosophy
Primary audience	IT professionals	End users
Place in the organization	Integral part of the Corporate Information Factory (CIF)	Transformer and retainer of operational data
Objective	Deliver a sound technical solution based on proven database methods and technologies	Deliver a solution that makes it easy for end users to directly query the data and still get reasonable response times

Table 1.Comparison of Essential Features of Inmon's and Kimbal's models

Differences in Development Methodologies and Architectures
In order to have an atomic data warehouse, as in Inmon's model, some degree of top-down development must be present. The atomic data warehouse must serve the entire enterprise, and all departmental databases obtain their data through the atomic data warehouse. Top-down development efforts have a certain unavoidable degree of complexity, and Inmon's methodology is no exception, although his clear presentation helps it seem less complex.

Overall, Inmon's methodology and architectural orientation is a technical one. His primary interest is ensuring that the technical solution works. Oversimplified, the objective of this technical solution is to optimize I/Os. Inmon's audience is clearly comprised of IT professionals. Few business readers have the background to understand Inmon's development approach because of its emphasis on technical aspects and a lack of understanding of the spiral development approach on which it is based. His emphasis on the technical aspects of the development implies that the IT department members of the data warehousing team will feel the greatest degree of ownership of the data warehouse as they, not the end users, will understand the development methodology. In contrast, Kimball's four-step development methodology is very accessible to the end user. A user can even understand moderately technical concepts of the data bus and conformed dimensions without extensive study, in contrast to learning to interpret ERDs. By definition, a bottom-up approach involves fewer data elements than a top-down development. Even if users are unfamiliar with the concept of a business process, the smaller scope of the data mart is more accessible to end users. Inmon's Meth2 helps make the enterprisewide scope less daunting, but the data mart scope is still considerably easier for users to grasp.

Differences in Data Modeling
Two obvious ways in which Inmon's and Kimball's data modeling differ are (1) orientation toward the data and (2) modeling rules and techniques.

In his own terms, Inmon takes a subject-oriented or datadriven approach to data modeling. This means that the nature of the data directs the data modeling process. This fits well with Inmon's traditional data modeling tools, such as ERDs and DISs. It also means that the IT members of the data warehouse team will have primary responsibility for data modeling, because the modeling tools and the thought processes they involve require a technical background to use effectively. End users can attend review presentations, but few could review ERDs or DISs unassisted unless they received fairly extensive special training.

In contrast, Kimball takes a process orientation, meaning that data modeling becomes an attempt to define the interaction of data across a business process (such as retail sales or inventory). By their natures, such business processes usually cross departmental lines. This fits well with the new data modeling approach of dimensional data modeling, in which the process determines which metrics (facts) and attributes (dimensions) are important enough to claim a place in the data warehouse. Dimensional modeling tools allow end users to take an active role in the data modeling process.

Philosophical Differences
By now it is clear that Inmon views IT as the primary developer and provider of the data warehouse. Inmon believes that the performance of the completed data ware-house will be maximized by ensuring a technically oriented development process. Meanwhile, Kimball sees end users and IT professionals sharing duties roughly equally. By ensuring the active participation of end users throughout the development process, the likelihood of user acceptance of the completed data warehouse is greatly enhanced.

Of course, both of these experts are well aware that a data warehouse that doesn't involve the users at all points in its lifecycle is just as likely to fail as one that performs poorly for the users. What the two do not agree upon is which of these considerations should be considered the most important.

Choosing the Best Approach
Following are guidelines for determining whether Inmon's or Kimball's approach is best suited to organization's data warehousing needs. Dave Wells addressed this problem in a TDWI FlashPoint article in early 2003 (Wells, 2003). He proposes 12 evaluation criteria that focus on the needs, environment, culture, and technical expertise of an organization planning to create a data warehouse. Of the 12, eight can be relatively easily categorized as favoring either Kimball's or Inmon's approach. Whether the remaining four elements (cost to operate, consistency of metadata and business rules, sustainability, and technology requirements) favor Kimball's or Inmon's approach would depend on the implementation of a given data warehouse project. To at least partially summarize the data in Table 1, an organization is more likely to succeed using Inmon's approach if it has a large team of data warehouse specialists, plans a large project with enterprisewide access needs, stores data that is not primarily business metrics, and can wait to see results over a longer timeframe--from four to nine months (Inmon, 2000). These characteristics and data requirements fit well with Inmon's recommendation to first build a considerable infrastructure on a solid enterprisewide data model.

On the other hand, an organization with different characteristics may be better off with a Kimball-based approach. According to one expert, "A typical requirement is to develop an operational data mart for a specific business area in 90 days, and develop subsequent data marts in 60 to 90 days each" (Mimno, 2002). Kimball's approach is generally recognized as faster than Inmon's, at least for the delivery of the first data mart (versus the first departmental database using Inmon's approach). Kimball's approach is also indicated if the organization is better able to field smaller teams of generalists for data warehouse project development, and expects to store mostly business metrics. An organization with these characteristics and requirements is more likely to succeed with a data mart architecture developed using the dimensional modeling approach.

Characteristic	Favors Kimball	Favors Inmon
Nature of the organization's decision support requirements	Tactical	Strategic
Data integration requirements	Individual business areas	Enterprisewide integration
Structure of data	Business metrics, performance measures, and scorecards	Non-metric data and for data that will be applied to meet multiple and varied information needs
Scalability	Need to adapt to highly volatile needs within a limited scope	Growing scope and changing requirements are critical
Persistency of data	Source systems are relatively stable	High rate of change from source systems
Staffing and skills requirements	Small teams of generalists	Larger team(s) of specialists
Time to delivery	Need for the first data warehouse application is urgent	Organization's requirements allow for longer start-up time
Cost to deploy	Lower start-up costs, with each subsequent project costing about the same	Higher start-up costs, with lower subsequent project development costs

Table 2. Specific Characteristics Favoring Inmon's or Kimball's Model

Table 2. Specific Characteristics Favoring Inmon's or Kimball's Model

It is important to realize that choosing an approach to data warehousing is not as simple as the two preceding paragraphs imply. However, as long as the reader understands that these guidelines represent a gross oversimplification of the process, they may be useful as a starting point for discussing the data warehousing needs and characteristics unique to a given organization.

Finally, research shows that having the right set of soft skills is just as important, if not more important, than technical skills and knowledge.

Interestingly, the keys to success are not technical in nature. Projects don't succeed because they use an innovative design or radical new technology. They succeed because of the "soft" stuff--leadership, communication, planning, and interpersonal relationships (Eckerson, 2003).

When building a data warehouse, whether using Inmon's or Kimball's approach, it is critical that the data warehouse team employ soft skills liberally and effectively. This involves ensuring that the organization has a well-articulated vision of the data warehouse's role and usage, and allocates sufficient resources to create and maintain the data warehouse (Eckerson, 2003). These are not typically responsibilities that an IT project development team must shoulder, yet they are critical to the success of a data warehouse project.

Summary
Data warehouses require storage and access of massive amounts of time-stamped data for decision support. Since the building of data warehouses was first attempted in the early 1990s, two models have emerged as dominant: Inmon's and Kimball's.

Inmon's approach stresses top-down development using proven database development methodologies and tools, such as ERDs, DISs, and a modification of the spiral development approach. Inmon's tools and methods are adaptations of traditional tools and methods for operational database development. Inmon sees the data warehouse as a part of a much larger information environment, which he calls the Corporate Information Factory (CIF). To ensure that the data warehouse fits well in this larger environment, he advocates the construction of both an atomic data warehouse and departmental databases.

Inmon's approach is evolutionary rather than revolutionary. His tools and methods can be actively used only by IT professionals. End users have a more passive role in the development process, mostly reviewing the results generated by IT professionals. Inmon's attention to the technical aspects of the data warehouse development process increases the chances of a sound technical solution. For end users, this is likely to mean very good query response times.

Kimball's approach is a departure from traditional database development. His bottom-up approach recommends building one data mart per business process. The sum of all data marts is the organization's data warehouse. The data bus is the aspect of Kimball's architecture that ensures interoperability between various data marts. The data bus requires that all data marts are modeled within consistent data standards called conformed dimensions.

Kimball recommends a four-step development process for each data mart, in which dimensional data modeling plays a central role. Dimensional data modeling involves fact tables that contain metric data, and dimension tables that modify that data. Dimensional modeling tools can be actively used by end users with some special training. This helps ensure that end users are actively involved in the development of the data warehouse. Ease of use and reasonable query response times in the final product (the data mart) are the dual goals of dimensional data modeling.

Inmon's and Kimball's models are similar in some ways, such as the treatment of time-stamped data. Although there are some differences in the ways in which each model handles this challenge, the two models are more similar than not in modeling the time attribute. Likewise, both models address the challenges of massaging operational data similarly. This process, called ETL, is one of the most labor-intensive aspects of the data warehouse.

Noted data warehouse expert Dave Wells suggests characteristics of organizations that favor the adoption of either Inmon's or Kimball's models. Some of these characteristics include the organization's decision support requirements, staffing and skills requirements, time to delivery and cost to deploy. His advice can help organizations begin the process of choosing an approach to developing their data warehouse.

Other research suggests that success in developing a data warehouse relies as much on the soft skills of the data warehouse team as on its technical expertise or business acumen. It is not surprising that a large IT-related project needs "...leadership, communication, planning, and interpersonal relationships" in order to succeed (Eckerson, 2003). What makes the data warehouse more of a challenge than a comparable operational development project is that the data warehouse technology is relatively new. A development team with a sound understanding of Inmon's and Kimball's models is in a much better position to articulate a vision of the data warehouse that matches the organization's characteristics and decision support goals.

BODY COMPOSITION AND NUTRITION

yasimk@gmail.com (Yasim) — Sun, 13 Apr 2008 21:40:00 +0000

SECTION VI
BODY COMPOSITION AND NUTRITION

Your weight and/or body fat was measured during your medical exam. Take a look at the weight allowed for your height as shown in Table 1. If you exceed the weight listed for your height, you may not be over fat. Some well-muscled individuals have body weights that far exceed the values for weight listed on the charts for their age, gender, and height. Yet, only a small percentage of their total body mass may be fat.

This standardized PT program meets the requirement to be physically active everyday. However, you will still need to make changes to your diet to so that you can report to IMT at an appropriate body composition. Losing one to two pounds per week is a realistic goal, which is best accomplished by a combination of eating less and exercising regularly.

Table 1. Screening table weight. Reproduced from AR 600-9, table 1.

People always want to know if a particular food is good or bad for them. No single food choice is necessarily a bad choice. Too many bad choices over time can accumulate into a poor diet. Poor
choices like a lunch of soda, chips, and a hamburger once in a while will be balanced out by a better choice like a turkey sandwich with low-fat dressing on whole wheat bread and fruit on a regular basis. Eating for performance and health doesn’t mean that you have to give up all of your favorite foods.

Build a healthy base by eating a variety of foods. Different foods contain different nutrients and other healthful substances. No single food can supply all the nutrients in the amounts you need. To make sure you get all the nutrients and other substances you need for health, build a healthy base by using the Food Guide Pyramid as a starting point. Choose the recommended number of daily servings from each of the five major food groups.

Breads, Cereals, Rice, and Pasta Group: Foods made from grains (wheat, rice, and oats) should form the foundation of a nutritious diet. They provide vitamins, minerals, carbohydrates

(starch and dietary fiber), and other substances that are important for good health. Grain products are low in fat, unless fat is added in processing, in preparation, or at the table. Whole grains differ from refined grains in the amount of fiber and nutrients they provide, and different whole grain foods differ in nutrient content, so choose a variety of whole and enriched grains. Eating plenty of whole grains, such as whole wheat bread or oatmeal may help protect you against many chronic diseases. You should consume at least 6-11 servings daily from the base of the pyramid.

Consuming the recommended daily intake is not difficult if you understand serving sizes. A ½ cup of cooked rice, cereal, or pasta is about the same size as your fist. The best choices from this food group are bran cereals, oat bran, low fat bagels (pumpernickel, rye, whole wheat), whole grain muffins (bran, corn and oat bran), whole grain breads and rice, and stoned wheat and whole grain crackers.

Vegetable Group: The vegetable group is one area where many people regularly fail to consume enough. Vegetables are nature’s vitamins. To ensure that you get essential vitamins and minerals, you should strive for 3-5 servings per day from this group. A serving size of raw or cooked vegetables is only ½ cup, and most people eat more. One cup of leafy raw vegetables is also a serving size, which is much smaller than the regular salad served with a restaurant dinner. A ½ cup of vegetables is about the size of a tennis ball. To maximize the vitamin and mineral content of your vegetables, don’t overcook. Cook in a microwave, steamer, or wok only until tender crisp. The lighter colored vegetables, such as cucumbers, iceberg lettuce, and celery are mostly fiber and water with very little calories, vitamins, or minerals. Choose dark green, orange, and yellow vegetables. The darker the vegetable, the more likely it is to have large amounts of vitamins and minerals. A variety of different vegetables should be consumed to ensure that you receive a variety of nutrients. Broccoli, spinach, green peppers, tomatoes, cauliflower, Brussels sprouts, collards, carrots, or winter squash are the best choices. A ¾ cup of vegetable juice also constitutes a serving from this group.

Fruit Group: The fruit group, in addition to providing vitamins and minerals, also provides fiber. Two to four servings of fruits are recommended each day. Breakfast is a good opportunity to eat some fruit. Drinking a glass of fruit juice for breakfast is a convenient way to get half of the minimum daily servings. Other good choices are citrus fruits, bananas, cantaloupe, kiwi, strawberries, and dried fruit. A serving size for the fruit group is one piece of medium sized fruit or melon wedge, or a ½ cup of chopped, canned, or cooked fruit. A ½ cup of fruit is about the same size as a tennis ball. If you choose fruit juice, make sure that it is not mostly sugar and contains a good amount of vitamins and minerals. A ¾ cup of fruit juice equals one serving. Juice that you can see through (apple, grape, or cranberry juice) usually contains more processed sugar than one that you cannot see through (orange juice, peach nectar, or prune juice).

Milk, Yogurt, and Cheese Group: These dairy products are a great source of protein, vitamins, and minerals (fortified by law) especially calcium and riboflavin. The milk group, however, can also contain a large amount of fat. Many no-fat or low-fat dairy products are available, including cheese, milk, sour cream, and yogurt. Top choices are 1% or skim milk, low-fat cheese, and yogurt. The recommended number of servings per day for this group is 2-3, and is easily attainable for most soldiers. One cup of milk or yogurt, a ½ cup of natural cheese (Cheddar or Swiss), or 2 ounces of processed cheese (American) is considered a serving size. 1 ounce of cheese is about the size of four dice.

Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Group: The Meat and Beans Group is very important for obtaining protein, vitamins, and minerals. Like the milk group, this group can contain large amounts of fat as well. Quick and easy choices include canned tuna, chicken, peanut butter, lentil soup, and beans. Two to three servings from this group are required each day. Most people are at one extreme or the other by consuming too much or not enough from this group. The serving sizes typically consumed greatly exceed the nutritional requirement. For example, a typical chicken breast (8 oz) equals 2 servings (and about 50 grams of protein) while the 16-ounce steak at your favorite restaurant equals 4 servings (and about 120 grams of protein) from this group. A serving size of cooked fish, poultry, or red meat is 2 to 3 ounces (the size of a regular deck of playing cards), a ½ cup of cooked dry beans, a 2 ½ ounce soyburger, 1 egg, 2 tablespoons of peanut butter, or 1/3 cup of nuts.

Fats, Oils, and Sweets Group: At the top of the food pyramid are the items that should be eaten in moderation. However, it does not mean that you should never eat these items. Most fats and sugars are nutrient poor. Foods from this group should be chosen in moderation because they often replace nutrient dense foods, so you may not get your daily requirement for the essential nutrients. For this reason, they are referred to as “empty” calories. This means that they provide nothing to the body except calories; no vitamins, minerals, fiber, water, or protein. Foods from this group are still an important part of a performance diet. Sweets add taste and flavor, while fat provides essential fatty acids like linoleic acid (part of every cell membrane), which can’t be made by the body. A better food preparation choice is baking, roasting, or grilling, however, frying food in fat (cooking oil) once in a while is all right. Top choices from this group include olive oil, walnuts, molasses, berry jams, or a favorite dessert. There are no suggested servings for the top of the pyramid because you always have plenty of opportunity to add these to their diet without even trying.

Choose natural or less processed foods whenever possible. An apple is a better choice than applesauce, which is a better choice than apple juice, which is a better choice than apple pie. A baked potato is a better choice than mashed potatoes, which is a better choice than potato chips. Whole grain (wheat) bread is usually a better choice nutritionally than white bread. Food processing tends to remove vitamins, minerals, and fiber and add undesirable or questionable additives.

Your pattern of eating is also important. Snacks and meals eaten away from home provide a large part of daily calories for many people. Choose them wisely. Try fruits, vegetables, whole grain foods, or a cup of low-fat milk or yogurt for a snack. When eating out, choose small portions of foods. If you choose fish, poultry, or lean meat, ask that it be grilled rather than fried. Also, notice that many of the meals and snacks you eat contain items from several food groups. For example, a sandwich may provide bread from the grains group, turkey from the meat and beans group, and cheese from the milk group.

CHOOSE SENSIBLY

The carbohydrates, fats, and proteins in food supply energy, which is measured in calories. High-fat foods contain more calories than the same amount of other foods, so they can make it difficult for you to avoid excess calories. However, low fat doesn't always mean low calorie. Sometimes extra sugars are added to low-fat muffins or desserts, for example, and they may be just as high in calories.

Fats supply energy and essential fatty acids, and they help absorb the fat-soluble vitamins A, D, E, and K, and carotenoids. You need some fat in the food you eat, but choose sensibly. Some

kinds of fat, especially saturated fats, increase the risk for coronary heart disease by raising the blood cholesterol. In contrast, unsaturated fats (found mainly in vegetable oils) do not increase blood cholesterol. Fat intake in the United States as a proportion of total calories is lower than it was many years ago, but most people still eat too much saturated fat. Eating lots of fat of any type can provide excess calories. The Nutrition Facts Label will state the number of grams of fat and sugar as well as protein, fiber, and sodium.

Saturated Fats: Foods high in saturated fats tend to raise blood cholesterol. These foods include high-fat dairy products (like cheese, whole milk, cream, butter, and regular ice cream), fatty fresh and processed meats, the skin and fat of poultry, lard, palm oil, and coconut oil. Keep your intake of these foods low.

Dietary Cholesterol: Foods that are high in cholesterol also tend to raise blood cholesterol. These foods include liver and other organ meats, egg yolks, and dairy fats.

Trans Fatty Acids: Foods high in trans fatty acids tend to raise blood cholesterol. These foods include those high in partially hydrogenated vegetable oils, such as many hard margarines and shortenings. Foods with a high amount of these ingredients include some commercially fried foods and some bakery goods.

Unsaturated Fats: Unsaturated fats (oils) do not raise blood cholesterol. Unsaturated fats occur in vegetable oils, most nuts, olives, avocados, and fatty fish like salmon. Unsaturated oils include both monounsaturated fats and polyunsaturated fats. Olive, canola, sunflower, and peanut oils are some of the oils high in monounsaturated fats. Vegetable oils such as soybean oil, corn oil, and cottonseed oil and many kinds of nuts are good sources of polyunsaturated fats. Some fish, such as salmon, tuna, and mackerel, contain omega-3 fatty acids that are being studied to determine if they offer protection against heart disease. Use moderate amounts of food high in unsaturated fats, taking care to avoid excess calories.

Following the tips listed below will help you keep your intake of saturated fat at less than 10 percent of your total calories:

Fats and Oils

· Choose vegetable oils rather than solid fats (meat and dairy fats, shortening).

· If you need fewer calories, decrease the amount of fat you use in cooking and at the table.

Meat, Poultry, Fish, Shellfish, Eggs, Beans, and Nuts

· Choose 2 to 3 servings of fish, shellfish, lean poultry, other lean meats, beans, or nuts daily. Trim fat from meat and take skin off poultry. Choose dry beans, peas, or lentils often.

· Limit your intake of high-fat processed meats such as bacon, sausages, salami, bologna, and other lunch meats. Try the lower fat varieties (check the Nutrition Facts Label).

· Limit your intake of liver and other organ meats.

· Use egg yolks and whole eggs in moderation. Use egg whites and egg substitutes freely when cooking since they contain no cholesterol and little or no fat.

Dairy Products

· Choose fat-free or low-fat milk, fat-free or low-fat yogurt, and low-fat cheese. Try switching from whole to fat-free or low-fat milk. This decreases the saturated fat and calories but keeps all other nutrients the same.

Prepared Foods

· Check the Nutrition Facts Label to see how much saturated fat and cholesterol are in a serving of prepared food. Choose foods lower in saturated fat and cholesterol.

Foods at Restaurants or Other Eating Establishments

· Choose fish or lean meats as suggested above. Limit ground meat and fatty processed meats, marbled steaks, and cheese.

· Limit your intake of foods with creamy sauces, and add little or no butter to your food.

· Choose fruits as desserts.

CHOOSE BEVERAGES AND FOODS THAT MODERATE YOUR INTAKE OF SUGARS

Sugars are carbohydrates and a source of energy (calories). Dietary carbohydrates also include the complex carbohydrates starch and dietary fiber. During digestion all carbohydrates except fiber break down into sugars. Sugars and starches occur naturally in many foods that also supply other nutrients. Examples of these foods include milk, fruits, some vegetables, breads, cereals, and grains.

Added sugars

Added sugars are sugars and syrups added to foods in processing or preparation, not the naturally occurring sugars in foods like fruit or milk. The body cannot tell the difference between naturally occurring and added sugars because they are identical chemically. Foods containing added sugars provide calories, but may have few vitamins and minerals. In the United States, the number one source of added sugars is non-diet soft drinks. Sweets and candies, cakes and cookies, and fruit drinks are also major sources of added sugars. Intake of a lot of foods high in added sugars, like soft drinks, is of concern. Consuming excess calories from these foods may contribute to weight gain or lower consumption of more nutritious foods. Some foods with added sugars, like chocolate milk, presweetened cereals, and sweetened canned fruits, also are high in vitamins and minerals. These foods may provide extra calories along with the nutrients and are fine if you need the extra calories.

Choose and prepare foods with less salt.

You may be able to reduce your chances of developing high blood pressure by consuming less salt. There is no way to tell who might develop high blood pressure from eating too much salt. However, consuming less salt or sodium is not harmful and can be recommended for the healthy, normal person. At present, the firmest link between salt intake and health relates to blood pressure. High salt intake also increases the amount of calcium excreted in the urine. Eating less salt may decrease the loss of calcium from bone. Loss of too much calcium from bone increases the risk of osteoporosis and bone fractures. Salt is found mainly in processed and prepared foods. Salt (sodium chloride) is the main source of sodium in foods. Only small amounts of salt occur naturally in foods. Most of the salt you eat comes from foods that have salt added during food processing or during preparation in a restaurant or at home. Some recipes include table salt or a salty broth or sauce, and some cooking styles call for adding a very salty seasoning such as soy sauce. Not all foods with added salt taste salty. Some people add salt or a salty seasoning to their food at the table. Your preference for salt may decrease if you gradually add smaller amounts of salt or salty seasonings to your food over a period of time.

IF YOU DRINK ALCOHOLIC BEVERAGES, DO SO IN MODERATION

Alcoholic beverages supply calories, but few nutrients. Alcoholic beverages are harmful when consumed in excess, and some people should not drink at all. Excess alcohol alters judgment and can lead to dependency and a great many other serious health problems. Taking more than one drink per day for women or two drinks per day for men can raise the risk for motor vehicle crashes, other injuries, high blood pressure, stroke, violence, suicide, and certain types of cancer. Even one drink per day can slightly raise the risk of breast cancer. Alcohol consumption during pregnancy increases risk of birth defects. Too much alcohol may cause social and psychological problems, cirrhosis of the liver, inflammation of the pancreas, and damage to the brain and heart. Heavy drinkers also are at risk of malnutrition because alcohol contains calories that may substitute for those in nutritious foods. If you choose to drink alcoholic beverages, you should consume them only in moderation and with meals to slow alcohol absorption.

Use of dietary supplements

Food supplementation is a multimillion-dollar business. There are thousands of supplements on the market, most of which are easily accessible. Supplements were traditionally defined as any product made of one or more of the essential nutrients such as vitamins or protein. That definition has to been broadened to include any product intended for ingestion as a supplement to the diet. Supplements include vitamins, minerals, herbs, amino acids, botanicals, as well as concentrates, metabolites, constituents, and extracts of these substances. Supplement product labels must include the words “dietary supplement”. Most products that meet this definition are not strictly regulated and are therefore not subject to any tight standards on ingredients or claims. Your primary goal should be to always strive to obtain the nutrients you need from the foods in your diet. Eating a variety of foods on a regular basis is the most important step toward this goal. Supplement powders and bars can be a convenient and portable method for busy people to ensure they are consuming adequate supplies of the essential nutrients. Variety is still important because bars and powders are not always low fat, inexpensive, or easily digested by all. Supplementation should be part of a larger plan for an optimal performance diet not a replacement for poor habits and choices. Nor are supplements a substitute for regular exercise.

There is no one magic pill or powder that you can take that will make you stronger, skinnier, or give you more energy. Information is key. If a product makes claims that sound too good to be true, the claims probably are too good to be true.

Additional benefits from CR training activities are the net caloric expenditure that impacts individual weight loss goals as a subset of the standardized physical training program. Each standardized physical training session expends approximately 300-400 kilocalories per session. Intensity and duration of exercise determine the total caloric expenditure during a training session, and are inversely related. For example, similar improvements in cardio-respiratory endurance may be achieved by a lower intensity longer duration regimen as with a higher intensity shorter duration program. However, the risk of overuse injury to the lower extremities is significantly higher in the former as opposed to the latter.

Healing Foods Pyramid

yasimk@gmail.com (Yasim) — Sat, 12 Apr 2008 20:53:00 +0000

The University of Michigan Integrative Medicine’s Healing Foods Pyramid was conceived by Monica Myklebust, MD, and Jenna Wunder, MPH, RD, in their passion for food in all of its beauty, variety, and healing benefits. The foods we choose to eat are essential to how we care for ourselves. In choosing the healing foods on this pyramid, each one of us contributes to our own health.

Click on the categories in the pyramid to access highlights for each food group

We emphasize:

Healing Foods
- Only foods known to have healing benefits or essential nutrients are included
Plant-based choices
- Plant foods create the base and may be accented by animal foods
Variety & balance
- Balance and variety of color, nutrients, and portion size celebrate abundance
Support of a healthful environment
- Our food, and we in turn, reflect the health of our earth
Mindful eating
- Truly savor, enjoy and focus on what you are eating

The pyramid shape was chosen due to its general familiarity. However, with the complexity of nutrition choices and concepts today, no two-dimensional model can fully convey all considerations. The categories and their placement on the pyramid generally support our intent, which is to emphasize the foundational role of Water, followed by the importance of a rainbow of Fruits and Vegetables. Grains emphasize whole grains and includes some starchy vegetables that act like grains in the body. Legumes are excellent sources of non-animal protein in this plant-based pyramid. Healthy Fats emphasizes monounsaturated oils and nuts. Eggs offer high quality protein and Dairy includes foods low in fat yet rich in calcium. Lean Meats complement other foods rather than playing the starring role. In Fish & Seafood, fish high in omega-3 fatty acids is emphasized. Seasonings include herbs, onions, garlic, pepper, salt and others that add flavor while contributing healing benefits. Dark Chocolate is a source of antioxidants and Alcohol, when used in moderation, has health benefits. Use of alcohol is to be guided by consideration of one’s personal health. Tea is recommended as a healthful beverage choice.

At the top of the pyramid is a personal space purposely left open. It is to be filled by you. What will make this Healing Foods Pyramid complete for you?

Facts About documents offer details of the recommendations. With the ever-changing ideas and research findings of food and nutrition, this Healing Foods Pyramid will be a continuous and dynamic work in progress.

High-fiber foods

Looking to add more fiber to your diet? Fiber moves quickly and relatively easily through your digestive tract and helps it function properly. A high-fiber diet may also help reduce the risk of heart disease and diabetes.

Here's a look at the fiber content of some common foods. Read nutrition labels to find out exactly how much fiber is in your favorite foods. Recommended fiber intake for women is 21 to 25 grams a day and for men is 30 to 38 grams a day.

Fruits	Serving size	Total fiber (grams)
Pear	1 medium	5.1
Figs, dried	2 medium	3.7
Blueberries	1 cup	3.5
Apple, with skin	1 medium	3.3
Strawberries	1 cup	3.3
Peaches, dried	3 halves	3.2
Orange	1 medium	3.1
Apricots, dried	10 halves	2.6
Raisins	1.5-ounce box	1.6
Grains, cereal & pasta	Serving size	Total fiber (grams)
Spaghetti, whole-wheat	1 cup	6.3
Bran flakes	3/4 cup	5.1
Oatmeal	1 cup	4.0
Bread, rye	1 slice	1.9
Bread, whole-wheat	1 slice	1.9
Bread, mixed-grain	1 slice	1.7
Bread, cracked-wheat	1 slice	1.4
Legumes, nuts & seeds	Serving size	Total fiber (grams)
Lentils	1 cup	15.6
Black beans	1 cup	15.0
Lima beans	1 cup	13.2
Baked beans, canned	1 cup	10.4
Almonds	24 nuts	3.3
Pistachio nuts	47 nuts	2.9
Peanuts	28 nuts	2.3
Cashews	18 nuts	0.9
Vegetables	Serving size	Total fiber (grams)
Peas	1 cup	8.8
Artichoke, cooked	1 medium	6.5
Brussels sprouts	1 cup	6.4
Turnip greens, boiled	1 cup	5.0
Potato, baked with skin	1 medium	4.4
Corn	1 cup	4.2
Popcorn, air-popped	3 cups	3.6
Tomato paste	1/4 cup	3.0
Carrot	1 medium	2.0

Grains and starchy vegetables

This Facts About explains and gives examples of grains and starchy vegetables. We list foods with a guide for selecting an appropriate portion size and provide recommendations for incorporating healthy changes into your diet.

What are the recommended servings of grains & starchy vegetables per day?

4 -11 servings per day. For optimal health, we recommend only whole grains versus milled, processed or refined grains.

What are whole grains?

Grains are the seeds of plants. Whole grains contain all parts of the grain, including the bran, endosperm and germ.

Bran. Forming the outer layer of the seed, the bran is a rich source of niacin, thiamin, riboflavin, magnesium, phosphorus, iron and zinc. The bran also contains the majority of the seed's fiber.
Germ. A concentrated source of niacin, thiamin, riboflavin, vitamin E, magnesium, phosphorus, iron and zinc. The germ also contains protein and fat.
Endosperm. Also called the kernel, the endosperm makes up the bulk of the seed. It contains most of the grain's protein and carbohydrate and has small amounts of vitamins and minerals.

What are milled, processed and refined grains?

Unlike whole grains that contain at least part of their bran and germ layers, milled, processed and refined grains have both the bran and germ removed during processing; therefore all of the nutrients in these layers are also removed.
They are often “enriched” which means nutrients that were lost during food processing are added back. For example, B vitamins, lost when wheat is refined, are added back to white flour during processing. However, even after enrichment, milled grains do not have as many nutrients as whole grains, and they do not provide as much fiber, if any.
While whole grains are preferred, adding fiber -rich foods to milled or processed grains can lower the glycemic impact and moderate fluctuations in blood sugar. Therefore, foods such as pasta and white rice can be part of a healthy diet when combined with high fiber foods such as vegetables or beans.
Examples of milled grains are white rice and white flour.

What are starchy vegetables?

Starchy vegetables include corn, potatoes (all kinds including sweet), winter squash, plantains, and yucca (cassava root)
These vegetables are higher in starch than other vegetables and are metabolized in your body more like a grain
They are often used as the central starchy part of a meal, for example: mashed potatoes or polenta (milled corn)
When used whole, they provide ample fiber and nutrients
Their primary function is to provide energy for the body, especially the brain and the nervous system. The body breaks down starches into glucose, which the body uses for energy.

Why choose whole grains and starchy vegetables?

They are rich sources of fiber and naturally low in fat
An important source of vitamins and minerals, such as B vitamins, Vitamin E, folate, selenium, zinc and iron
They contain a variety of phytochemicals and antioxidants
They help form the foundation of healthy eating
There is a wide variety to choose from
Tend to have a low glycemic index, which helps to regulate blood sugar levels
Associated with reduced risk of type 2 diabetes, constipation, diverticulitis, obesity, heart disease and some tyepes of cancer

Try replacing refined, processed and milled grains with a whole grain alternative

Choose Less Often		Choose More Often
Milled/Refined Grains & Starchy Vegetables	Serving Size	Whole Grains and Starchy Vegetables	Serving Size
White / wheat bread	1 slice (1oz)	Whole wheat / whole grain bread	1 slice (1 oz)
White Rice	1/3 cup	Brown rice, millet, quinoa, barley or polenta	1/3 cup
Couscous	1/3 cup	Whole wheat couscous	1/3 cup
Pasta	1/3 cup	Whole wheat / multi grain pasta	1/3 cup
Crackers and Pretzels	3/4 oz	Whole grain crackers and pretzels	3/4 oz
Potato chips	3/4 oz	Tortilla chips	3/4 oz
Potato without skin	1 med	Potato with skin	1 med
Bagel, 4oz	1/4	Whole wheat / whole grain bagel, 4 oz	1/4
Pancake or waffle, 4 inches across	1	Whole grain pancake or waffle, 4 inches across	1
Pita bread, 6 inches across	1/2	Whole wheat pita, 6 inches across	1/2
Corn flakes, sugary breakfast cereal	3/4 cup	Oatmeal, cereal based on oats, barley or bran	3/4 cup

Specific Considerations

What is the glycemic index (GI)?

The glycemic index measures how different types of carbohydrate foods affect blood glucose (blood sugar) levels. The higher a food ranks on the glycemic index, the faster it increases glucose in the blood. Eating more than the recommended servings of foods high on the glycemic index can lead to loss of sensitivity to insulin, the hormone needed to allow blood sugar to enter cells for use as fuel. This "insulin resistance" promotes weight gain and type 2 diabetes.

The glycemic index ranks carbohydrates on a scale from 0 to 100 according to the rate and extent that the sugars from these carbohydrates enter the blood and cause blood sugar levels to rise after eating
Carbohydrates that breakdown quickly have the highest glycemic indexes
Carbohydrates that breakdown slowly have low glycemic indexes

What is the glycemic load (GL)?

GL builds on the glycemic index concept to provide a measure of total glycemic response to a food or meal based on serving size
GL = GI (%) x grams of carbohydrate per serving

GI and GL Range Values

Glycemic Index (GI) Range	Glycemic Load (GL) Range	Glycemic Load per Day
Low GI = 55 or less	Low GL = 10 or less	Low GL <>
Medium GI = 56-69	Medium GL = 11-19	High GL > 120
High GI = 70 or more	High GL = 20 or more

Milled Grains and GI

When the fiber is removed from grains during the milling process, the refined carbohydrate that remains is converted to glucose by the body much more quickly during digestion. Therefore the milling process increases the GI of a particular grain, for example:

Grain	Glycemic Index (GI)	Glycemic Load (GL)
Milled - White rice, instant, 1 c	87 - High	36 - High
Whole - Brown rice, 1 c	50 - Low	16 - Medium

Fiber in the prevention of chronic disease

Constipation
Fiber adds bulk, aiding the movement of food through the gut, thus preventing constipation

Diverticulitis
Fiber also helps reduce the risk of diverticulitis, a condition in which small pouches in the colon wall may become infected

Type 2 Diabetes
Foods with a low glycemic index and high fiber, like many whole grains and starchy vegetables, do not raise blood sugar levels as quickly as milled and processed choices. Therefore, they are associated with a lower risk of type 2 diabetes. Low glycemic index foods are often high in fiber and include legumes, whole fruits, oats, bran and whole grain cereals.

Heart Disease
Fiber reduces fat and cholesterol absorption leading to lower total and LDL (bad) cholesterol levels

Obesity
Because insoluble fiber is indigestible and passes through the body virtually intact, it provides few calories. Since the digestive tract can handle only so much bulk at a time, and since fiber-rich foods are more filling than other foods, people on high fiber diets tend to eat less. Insoluble fiber also may hamper the absorption of calorie-dense dietary fat.

Cancer
Whole grains contain phytochemicals and antioxidants that can help lower your risk for cancer. Also, the fiber in whole grains can help move potential cancer- causing compounds through the intestines faster, reducing their chances of being reabsorbed into the body.

What are the health concerns associated with grains?

Gluten Intolerance

Celiac disease (CD) is also known as gluten intolerance. Gluten is the common name for the proteins in specific cereal grains that are not tolerated in persons with CD. These proteins are found in all forms of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains, rye, barley, and tritcale. When individuals with CD ingest gluten, the villi, tiny hair-like projections in the small intestine that absorb nutrients from food are damaged. This is due to an immune reaction to gluten. Damaged villi interfere with the body's ability to absorb basic nutrients - proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts.

Pesticide Use

Pesticides are chemicals that are used to control pests that destroy crops. They are used in the production of most crops sold in the United States. These chemicals may increase your risk for cancer or other chronic diseases and should be limited in your diet.

Choose Organic

We recommend organic grains because they contain less pesticide residue. We believe they also provide better flavor and are a better nutritional choice than conventionally grown produce.

Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations. Organic food is produced without using most conventional pesticides, petroleum-based fertilizers, or sewage sludge-based fertilizers, bio-engineering, or ionizing radiation. Organic systems replenish and maintain soil fertility, eliminate the use of toxic and persistent pesticides and fertilizers, and build biologically diverse agriculture.

How can you get more fiber and whole grains into your diet?

Reduce the amount of refined grains you eat. A good way to be sure a food item contains whole grains is to look at the fiber content-3 or more grams of fiber per serving is recommended.
Use breakfast cereals based on oats, barley and bran for breakfast or a snack.
Use “grainy” breads made from whole seeds.
Eat brown rice instead of white rice.
Experiment with cooking various whole grains like quinoia, barley and millet.
When buying bread products, read the label. If you see the word enriched, the product probably does not contain whole grains.
Wheat flour and whole wheat flour are not the same! Look for whole grain, stone ground, whole ground, whole wheat flour, whole oat flour or whole barley flour.
When eating a milled or processed grain, add foods with plenty of fiber (fruits, vegetables, legumes or whole grains) to lower glycemic impact.
Many foods are now available in whole wheat / whole grain versions: pasta, couscous, frozen waffles, pancake mixes, crackers, bagels and pretzels.

This Facts About document is published by Monica Myklebust, MD, and Jenna Wunder, MPH, RD, at University of Michigan Integrative Medicine Clinical Services. Our mission is to care for people using an Integrative Medicine model that reaffirms the importance of relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.

Legumes

This Facts About reviews beans and lentils and gives examples of foods to choose from as well as foods to avoid. We provide a guide for selecting an appropriate portion size, and recommendations for incorporating healthy changes into your diet.

What are the recommended servings per day?

1-3 servings per day

Why choose legumes?

Low in fat
Excellent source of protein
Good source of fiber
Contain iron, zinc, calcium, selenium, and folate
Rich in antioxidants
Provide a low glycemic index (GI) / glycemic load (GL)
May help reduce the risk of chronic diseases, such as, heart disease, diabetes mellitus,obesity and cancer

What are legumes?

Beans, peas, lentils, and peanuts are collectively known as legumes, which are plants that have pods with tidy rows of seeds inside. Various foods in this category metabolize differently and provide different nutrients. For example, peanuts, which are usually consumed in ways similar to tree nuts are actually in thelegume family and grow underground. They contain more fat and fewer carbohydrates than other legumes. Sugar snap peas contain fewer calories, carbohydrates, and protein per serving than other legumes and are used in cooking as a vegetable. Soy beans are unique for their high isoflavone and essential amino content. They are also used to make such a wide variety of foods unlike other beans in this category. For these reasons, we have listed peanuts in Healthy Fats, fresh green peas in Vegetables, and soy beans in Soy. Please read these individual Facts About sheets for more information.

Legumes have many of the nutrients recognized as important in preventing heart disease, cancer, obesity, and other chronic diseases. They are a vegetarian source of protein for the diet. For non vegetarians, they offer an alternative source of protein with less fat and more fiber.

Selected Food Sources with Serving Sizes, Protein, and Fiber Content

Selected Food Sources of Legumes
Types	Serving Size	Protein and Fiber Content
Beans: garbanzo beans (chickpeas), lima beans, fava beans, black beans, black-eyed peas, kidney beans, navy beans, great northern beans, pinto beans, adzuki beans, mung beans	1/2 cup canned or cooked 1/3 cup mashed	Provides approximately 8 grams of protein & 8 grams of fiber
Peas: split, yellow or green
Lentils: large or small; brown, green, red or black

Specific Considerations

Protein Complementation

Protein is made up of building blocks called amino acids and must be consumed in the diet for building new proteins in the body. Our bodies can make some amino acids from the protein we eat, but not others; the ones the body cannot make are considered essential amino acids because they must be consumed from the diet.

Dairy and meat usually contain all of the essential amino acids and are considered to provide complete proteins. However, they often contain saturated fat and cholesterol.
Grains, fruits and vegetables lack at least one of the essential amino acids and are considered to provide incomplete proteins. These items, when eaten in combination can fulfill requirements for essential amino acids in the diet.
For the most benefit from complimentary protein foods, plant sources of protein such as legumes, seeds and whole grains should be eaten in combination and during the same day, but do not necessarily need to be eaten during the same meal as once thought.
There are many examples of common plant-based dishes that contain adequate essential amino acids: brown rice and beans, peanut butter and whole wheat bread, cornbread and pinto beans and refried beans with wheat or corn tortillas.
Dairy products can also be added to a meatless dish to enhance the protein content of a meal.

Canned versus Dried Beans

Canned beans are fast and easy to use
Many canned beans are high in sodium. To avoid this, buy “no added salt” products or rinse thoroughly.
Dried beans have a fresher taste than canned beans and soaking times vary. Read product label for instruction.

Intestinal Gas

Many people who eat beans have a problem with intestinal gas. Humans are missing an enzyme required to break down raffinose sugars found in beans. The bacteria in our gut feast on these sugars, giving off hydrogen and carbon dioxide and causing intestinal gas. Some people avoid beans due to the intestinal gas or bloating they may produce. Gradually increasing the amount of beans you eat over several weeks can help in overcoming this.

Ideas to increase beans, peas & lentils

Choose beans as your protein choice instead of high fat meat or dairy products.
Keep pantry stocked with a variety of canned legumes for a quick meal or side dish.
If you're new to beans, start with a small amount and increase gradually.
Consider vegetarian days.
Change your favorite recipe by replacing half the meat with legumes.
Try a new legume each week.
Enjoy bean soups and a salad for lunch and / or dinner.

To decrease intestinal gas from beans, peas, & lentils

Mix 1/8 teaspoon of baking soda into the soaking water. It helps leach out raffinose sugars, reducing intestinal gas.
Drain and rinse canned beans. That will get rid of some of the gas-causing raffinose sugars (and almost half of the unwanted sodium).
Never cook beans in the water they've soaked in. It's loaded with the gas-causing raffinose sugars.

This Facts About document is published by Monica Myklebust, MD, and Jenna Wunder, MPH, RD, at University of Michigan Integrative Medicine Clinical Services. Our mission is to care for people using an Integrative Medicine model that reaffirms the importance of relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.

Fruits and Vegetables

This Facts About reviews fruits and vegetables and gives examples of foods to choose. We provide a guide for selecting an appropriate portion size, and recommendations for incorporating healthy changes into your diet.

What are the recommended servings per day?

Overall: more than 7 servings
Vegetables: unlimited (minimum 5 servings)
Fruits: 2-4 servings

Why should you choose fruits & vegetables?

Excellent source of fiber
Rich in vitamins and minerals
Low in calories and most are fat-free
Provide a food source of water; fruits and vegetables are made up of more than 50% water
Abundant in phytochemicals and antioxidants
High consumption helps reduce risk of various diseases such as cancer, obesity, heart disease, arthritis, asthma, macular degeneration and diverticulosis

What is the threshold effect?

Research supports evidence of an inverse relationship of fruit and vegetable consumption with development of chronic disease. This means that the more fruits and vegetables you eat, the less likely you are to develop a chronic disease. The most significant reductions in risk of illness are seen when individuals consume 7-10 servings of fruits & vegetables per day (the threshold). Therefore, to get the most health benefits we recommend a minimum “threshold” of 7 servings of fruits & vegetables daily.

A limited selection of fruits and vegetables

Fruits		Vegetables
Apricots	Oranges	Asparagus	Parsnips
Blackberries	Papaya	Bell peppers	Radicchio
Blueberries	Passion fruit	Bok choy	Radishes
Cantaloupe	Peaches	Broccoli	Sorrel
Dates	Plums	Cabbage	Spinach
Guava	Pomegranate	Carrots	Swiss chard
Grapefruit	Raspberries	Cucumbers	Tomato
Honeydew melon	Star fruit	Green beans	Turnips
Kiwifruit	Tangelos	Kale	Watercress
Mango	Watermelon	Kohlrabi	Zucchini

Selected serving sizes of fruits & vegetables

Fruit or Vegetable	Serving Size
Raw leafy greens	1 cup
Baby carrots	6-7
Apple/Orange	Size of tennis ball
Banana	Medium
Grapes	17
Berries	¾ cup
Melon	chopped 1 cup
Raw, chopped fruit or vegetables	½ cup
Cooked vegetables	½ cup
Dried fruit	¼ cup

Specific Considerations

Phytochemicals

Phytochemicals (‘phyto’means plant) are naturally occurring plant chemicals
Phytochemicals are not yet classified as nutrients. Nutrients are substances necessary for sustaining life. Phytochemicals’ role in nutrition is still unfolding however, they have been identified as containing properties that aid in disease prevention
In the human body, some phytochemicals act as antioxidants, some protect and regenerate essential nutrients, while others work to deactivate cancer-causing substances
Thousands of phytochemicals have been identified in the plant foods we eat
One serving of fruit or vegetables may contain 100 different phytochemicals. Some are available when the vegetable is raw, and others when the vegetable is cooked. It is important to eat a mix of raw and cooked vegetables to gain the most benefit from phytochemicals.

Cooking method matters; steaming helps retain water soluble vitamins like B vitamins and vitamin C rather than boiling
High cooking temperature and long cooking times also destroy heat sensitive nutrients such as B vitamins, vitamin C, and folate, so keep cooking times short

Antioxidants

The most well known phytochemicals are the antioxidants

Antioxidants found in fruits and vegetables protect cells from damage caused by metabolic by-products (free radicals), as well as toxic substances from food and the environment. As our bodies use oxygen to produce energy, these free radicals are formed. They damage cells which may lead to cellular dysfunction and disease
Colorful plant foods are loaded with antioxidants so eating a variety of fruits and vegetables is a great way to protect the body from oxidation, and therefore reduces the risk of numerous health conditions

Examples of antioxidants:

Beta carotene - carrots, cantaloupe
Vitamin C - citrus, cantaloupe, mango, and kiwi
Vitamin E - dark leafy greens, broccoli
Selenium – mushrooms, cabbage

Rainbow of Color

Phytochemicals contribute to the pigments of fruits and vegetables:

Red - lycopene found in tomatoes, watermelon, & pink grapefruit
Orange - beta carotene found in carrots, mangoes, & cantaloupe
Yellow - beta cryptothanxin found in pineapple, oranges, & peaches
Green - indoles found in broccoli, cabbage, & kale
Purple - anthocyanins found in blueberries, grapes, & eggplant
White – allicin found in garlic, onions, & chives

Research tells us that the more phytochemical-rich foods eaten, the lower the risk for diseases such as cancer and heart disease. Therefore we recommend eating a rainbow of fruits and vegetables daily.

Pesticide Use

Wash all fruits and vegetables with water
Before eating apples, cucumbers, potatoes or other produce in which the outer skin or peeling is consumed, scrub with a brush
Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage
Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled

Choose Organic

We recommend organic fruits and vegetables because they contain less pesticide residue. We believe they also provide better flavor and are a better nutritional choice than conventionally grown produce.

According to the Consumers Union and The Environmental Working Group, the top fruits and vegetables to buy organic because of potential pesticide residue are:

Peaches
Apples
Pears
Green beans
Grapes
Strawberries
Raspberries
Spinach
Tomatoes
Cantaloupe

Ways to Transition to Organic Fruits and Vegetables

Shop at farmers markets
Buy a share in a community supported agriculture (CSA) program
- For more information, check out http://www.nal.usda.gov/afsic/csa/
Join a food co-op
Buy organic produce in-season and freeze/preserve
Grow your own fruits and vegetables
Ease into buying organic produce

Ideas to Increase Fruits and Vegetable Consumption

Do it gradually.
Snack on raw vegetables instead of chips and crackers. To keep it interesting, try dipping vegetables in hummus, salsa or low-fat dip.
Add fruit to your cereal or yogurt at breakfast.
Order salads as an appetizer when out to dinner.
Get creative. Add vegetables to dishes that don’t always include them, like scrambled eggs, rice or pasta dishes, pizza and casseroles.
Drink your fruit (including fruit just past it’s prime) in the form of a fruit smoothie.
Choose salads as your main course for lunch or dinner. For variety, top your salads with dried cranberries, sunflower seeds or other nuts.
In hot weather, frozen fruit such as grapes, sliced kiwis, sliced peaches and strawberries are a refreshing snack.
Enjoy salad bars at restaurants or grocery stores.
When craving a sweet treat, try dried fruit.
Buy fresh fruits and vegetables in season.
Frozen fruit and vegetables are frozen soon after harvest and can be eaten during the off season as a nutritious alternative to fresh produce.
Watch local grocery advertisements for reduced prices on your favorite fruits and vegetables.
Try fruit for dessert.
Prepare fruits and vegetables ahead of time in a way you like to eat them so they are readily available and desirable to you when you are hungry.
Fill half of your plate with fruits and/or vegetables.
Choose a rainbow of fruits and vegetables daily.

Diary

This Facts About reviews low-fat/non-fat dairy and gives examples of foods to choose from as well as foods to avoid. We provide a guide for selecting an appropriate portion size, and recommendations for incorporating healthy changes into your diet.

What are the recommended servings per day?

Optional: 1-3 servings per day

Why choose low-fat/non-fat dairy products?

Though many foods contain calcium, dairy foods are some of the richest sources of calcium
They are high in protein, vitamin B12 and other minerals the body needs, such as selenium, zinc, phosphorus, potassium and magnesium
Most milk is fortified with vitamin D, which helps the small intestine absorb calcium
Low-fat and fat-free milk are also typically fortified with vitamin A, which is lost in the removal of milk fat
Selecting low-fat/non-fat dairy products helps reduce total and saturated fat intake and calories
While low-fat and non-fat dairy products are made using 1%, ½%, or non-fat milk instead of using whole milk or cream, artificial ingredients may be added to enhance color, shelf-life, and texture. Read labels and avoid products if the ingredients are chemicals or names too long to pronounce.
Although recent research suggests that dairy product intake may be associated with lower body weight or body fat, definitive evidence is pending.

Why choose fermented/probiotic milk products such as yogurt?

Probiotic foods contain healthy living bacteria. Eating such foods can help re-establish a healthy bacteria balance in the digestive tract that may have been disrupted by poor diet or medications. Research has shown that the healthful bacteria in yogurt may provide many benefits, such as:

Offering a safe and effective means of treating acute infectious diarrhea in children
Preventing antibiotic-associated diarrhea
Protecting against tumor formation in the colon
Reducing intestinal transit time which helps prevent constipation
Improving the digestion of lactose in persons with lactose intolerance
Enhancing gut and systemic immune function by increasing IgA antibody production
Preventing allergic reactions by reducing hypersensitivity reactions
Helps reduce symptoms of inflammatory bowel disease (IBD) such as Crohn’s and ulcerative colitis
Increasing HDL (good) cholesterol and decreasing the ratio of LDL (bad) to HDL cholesterol with long-term, daily intake of yogurt; this may be due to the fatty acid distribution and the type of fats in the milk

Other fermented milk products, such as low-fat/non-fat sour cream, cottage cheese, and cheeses (Swiss and Cheddar), may have similar benefits.

Selected Food Sources with Serving Sizes

Selected Low-fat Dairy Sources

1-3 servings per day
Select from the following with less than 3g fat per serving

Low-fat/non-fat yogurt (1 cup)

Low-fat/non-fat frozen yogurt (1 cup)

Low-fat/non-fat cottage cheese (1/2 cup)

Low-fat/non-fat cream cheese (1 tbsp)

Low-fat/non-fat sour cream (2 tbsp)

Part-skim ricotta cheese (1 oz or 1/8 cup)

Part-skim mozzarella (1 oz)

Skim milk (non-fat), 1/2%, or 1% (1 cup)

Specific Considerations

Choosing low-fat/non-fat dairy products

Low-fat dairy products have less than 3 g of total fat per serving
Check expiration date on containers
Choose dairy products from "free-range", "grass-fed" or "organic" animals to minimize consumption of antibiotic residues and other toxins

Full-fat cheese

Although full-fat cheese is high in total fat and saturated fat, small amounts of natural, minimally processed cheese can be an important dietary component. The Mediterranean diet, known for its health benefits, includes small amounts of cheese almost daily. Full-fat cheese should be consumed in small portions.

Buy high-quality cheese made by local farmers or imported from reputable creameries. This decreases the chance of antibiotic and hormone residues and use of trans-fats/hydrogenated oils as a means of processing cheese to increase shelf-life. Avoid pre-packaged cheeses for the same reasons.

Examples of Full-fat Cheeses

Up to 1 serving per day Serving size 1-2 oz
Soft	Brie, Mascarpone
Semi-hard	Blue, Feta
Hard	Cheddar, Swiss
Very hard	Parmesan, Romano

Lactose Intolerance

Many people are lactose intolerant, meaning that they lack the enzyme lactase that breaks down the natural sugar (lactose) found in dairy products. Around the world, various ethnic groups have different proportions of those who are lactose intolerant; approximately 90% of Asians, 70% of African and Native Americans and 50% of Hispanics are lactose intolerant, versus only about 15% of people of Northern European descent.

Lactose intolerance can cause bloating, gas, and stomach aches after intake of dairy products. Symptoms may be avoided by choosing fermented dairy products such as yogurt or lactose free milk.

Casein Sensitivity

The milk protein casein, found in dairy products, stimulates the production of mucus in some people and can potentially aggravate conditions like auto-immune disease, asthma, bronchitis or sinusitis. Some studies suggest that casein may irritate the immune system which should be considered by people who have “overactive immune systems” – often manifested by chronic allergies, lupus and rheumatoid arthritis, for example.

Choose Organic

We recommend organic, free-range animal products because they contain less antibiotic or hormone residue and have a higher omega-3 and vitamin E content. These qualities make organic animal products a better nutritional choice. We believe they generally provide better flavor than conventionally raised animals.

Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations. Organic meat, poultry, eggs, and dairy products come from animals that are given no antibiotics or growth hormones. With the increase in incidence of hormone-related diseases such as breast and prostate cancer, it may be prudent to consume only organic dairy products.

Hormones and Antibiotics

Most commercial animal products contain residues from drugs, hormones, and chemicals used to keep modern dairy cows producing abundantly. These residues in food may increase the risk of breast cancer and other hormone-related cancers including prostate cancer.
Most commercially-raised animals may have been exposed to antibiotics. This practice contributes to the escalating problem of antibiotic-resistant bacteria throughout the world.

Know Your Limits for Fat

On a 2,000 calorie diet, about 30% or 600 calories (67g) should come from total fat per day
A ratio of 1:2:1 of saturated: monounsaturated: polyunsaturated (such as Omega-3s) fat should be the goal. 1:2:1 in calories equals 150:300:150 - no more than 150 calories or 7.5% (17g) of total calories should come from saturated fat
A low-fat dairy product has less than 3g of fat per serving

Ideas for your dairy consumption

Freeze yogurt for a frozen dessert. Research shows that probiotic bacteria can survive the freezing process, so freezing yogurt will not diminish its health benefits.
Plain yogurt, mixed with fresh fruit, makes a quick and easy snack. Since plain yogurt has no added sugars choosing it reduces your sugar and calorie intake. Additionally you get added fiber and antioxidants from the fresh fruit!
Use cottage cheese like a dip for raw vegetables and whole grain pretzels or pita chips.
Full-fat cheese has big flavor (and lots of fat). An ounce or two can be a satisfying treat.

Seasonings

This Facts About reviews spices and herbs and gives examples. We provide a guide for selecting an appropriate portion size, and recommendations for incorporating healthy changes into your diet.

What are the recommended servings per day?

Use a variety of spices, herbs, and alliums in your daily food preparation. Experiment cautiously with hot peppers.

What are spices, herbs, alliums and hot peppers?

Herbs refer to leaves of low-growing shrubs. They can be used fresh or dried.
Spices may be the seeds, buds, berries, bark, root, or fruit of tropical plants and trees
Alliums are bulbous plants that are used as flavoring for foods and for their medicinal properties. They are found in most regions of the world except the tropics, New Zealand and Australia.
Hot peppers are edible, pungent fruits of the species Capsicum. They are used as spices and flavoring for foods and for their medicinal properties.

Why choose a variety of seasonings?

Seasonings are grown for their culinary and medicinal properties
They may be helpful in many medical conditions, such as:
- Nausea
- Infections
- Anti-inflammatory conditions
- Autoimmune disorders
- High blood pressure
- Cholesterol levels

Selected Food Sources - The following information is not meant to be an exhaustive list. Due to limited space, we have highlighted only a few of the many beneficial seasonings.

Selected Seasonings
Spices	curry, turmeric, cumin, chili pepper, fennel, cinnamon, ginger, cloves, nutmeg, allspice, mustard seed, black pepper, paprika, salt, cardamom, vanilla, horseradish, anise
Herbs	parsley, chives, thyme, sage, oregano, mint, rosemary, tarragon, basil, dill, cilantro, coriander, marjoram, caraway, savory
Alliums	green onions, onions, shallots, leeks, chives, garlic
Hot Peppers	cayenne, jalapeno, Anaheim , chipotle, habanero, Serrano, ancho

Special Considerations

Whole Turmeric in Powdered Form

Tumeric is the yellow spice most familiar in Indian cooking and American prepared mustard
Has antioxidant and anti-inflammatory properties
May decrease symptoms of autoimmune disorders, arthritis, tendonitis, and other disorders with inflammation
Curcumin is the part of turmeric that gives the yellow color

Fresh Ginger Root

Ginger is an underground stem or rhizome which sprouts large pink and orange flowers that look as if they have been carved out of wax
Has anti-inflammatory properties
Helps with nausea and motion sickness
Decreases symptoms of arthritis and bursitis
Reduces platelet aggregation

Fresh Garlic Cloves

Garlic cloves are the segments of a head or bulb of garlic
Natural antibiotic and antiviral agent as a result of sulfur-containing compounds
May help with infections: colds, sore throat, ear infections in children, fungal or yeast infections
May slow development of atherosclerosis, improve high blood pressure and decrease total and LDL (bad) cholesterol by reducing blood platelet stickiness and artery spasms
May decrease risk of developing colorectal, prostate, breast, liver, skin, and digestive tract cancers by inhibiting the growth of tumors and stimulating the immune system

Fresh or Dried Peppermint

Fresh or dried peppermint are the leaves from the peppermint plant
Used as a digestive remedy for relief of heartburn, indigestion, and nausea
May soothe the lower GI tract by decreasing spasms and gas formation
Contains antioxidants called flavonoids which stimulate bile and saliva production
Its soothing effect results from the stimulation of salivation, which increases the swallowing reflex and suppresses cough

Cayenne Pepper

A very pungent spice produced by drying and grinding the orange to deep-red fruits of small-fruited species of Capsicum
Capsicum is used to stimulate digestion
Eases toothache pain
Improves peripheral circulation
Reduces blood clotting tendencies
Decreases cholesterol
Helps to prevent arteriosclerosis and heart disease

Whole food vs. supplements

Whole foods are the best sources of vitamins, minerals, and other plant compounds that help you stay healthy and fight disease
We recommend these foods in their natural form. Taking them in supplement form may reduce their effectiveness and may increase the risk of side effects.

Interactions with medications and medical conditions

Because of their medicinal qualities, some spices and herbs may interact with medications. We advise individuals to contact their physician if taking medications.

How to use seasonings

Spices and herbs should be stored in a cool, dry place.
Green herbs should be protected against direct sunlight exposure.
Ground spices release flavor immediately, therefore add them at the end of the cooking period.
Whole spices should be added at the beginning of cooking so their full flavor can be extracted.
Crumbling whole herbs just before use helps to release their flavor.
Chopping or mashing garlic releases an active medicinal component, allicin.
To reduce the heat of hot peppers, remove the seeds.
Fresh herbs can be added to salads, soups and sauces.

Healthy Fats

This Facts About reviews healthy fats and gives examples of foods to choose from as well as foods to avoid. We provide a guide for selecting an appropriate portion size, and recommendations for incorporating healthy changes into your diet.

What are the recommended servings per day?

3-9 servings per day (see serving sizes below)

What are the different types of healthy fats and oils?

Fats and oils are made up of basic units called fatty acids. Each type of fat or oil is a mixture of different fatty acids.
Monounsaturated Fatty Acids (MUFA) are found mainly in vegetable oils, nuts, seeds and some plant foods. They are liquid at room temperature.
Polyunsaturated Fatty Acids (PUFA) are found mainly in vegetable oils, fish and seafood. They are liquid or soft at room temperature. Omega-3 and omega-6 fatty acids are types of PUFA and are considered essential fatty acids because our bodies cannot make them, thus they must be obtained through the diet.
Saturated Fatty Acids are usually solid at room temperature and are found mainly in foods from animal sources like meat, dairy products and butter. Some vegetable oils such as coconut, palm kernel and palm oil are saturated.
Trans Fatty Acids are liquid vegetable oils that have been chemically processed to become solid at room temperature through the addition of hydrogen atoms. These hydrogenated and partially hydrogenated oils are used in some margarines and fried foods as well as to improve the flavor, texture and shelf-life of processed snack foods like cookies and crackers.

Which fats are recommended?

Emphasize consumption of monounsaturated and omega-3 fatty acids
Limit consumption of saturated and trans fats (listed as hydrogenated or partially hydrogenated vegetable oils on labels)
All foods containing fat have a mixture of polyunsaturated, monounsaturated, and saturated fatty acids. It is not feasible or desirable to completely eliminate one type of fatty acid from your diet.

Why choose healthy fats like MUFA and omega-3s?

They provide antioxidants such as vitamin E and selenium
Small amounts of healthy fats help the body absorb the vital nutrients from fruits and vegetables
Including healthy fatty acids in the diet in appropriate quantities can help prevent and treat: diabetes, heart disease, cancer, obesity, musculo-skeletal pain, inflammatory conditions
Some research suggests that diets including MUFA can have a positive effect on cholesterol, blood pressure, blood clotting and inflammation.
Omega-3 fatty acids are necessary for proper brain growth and development. They are anti-inflammatory and may be helpful in the prevention and treatment of heart disease, high blood pressure, inflammation, mental health disorders, diabetes, digestive disorders, autoimmune disease and cancer.

Why should I avoid saturated and trans fatty acids?

Saturated fat eaten in excessive amounts is the main culprit in raising total and LDL “bad” cholesterol, which can increase risk of heart disease.
Trans fatty acids may act like saturated fats in the body and raise LDL cholesterol levels. They may also lower HDL (“good”) cholesterol.
A food item may contain less than 0.5 grams of trans fat per serving but still reflect “0” grams of trans fat on its food label. To ensure that the foods you eat are actually free of trans fat, check that hydrogenated and partially hydrogenated vegetable oils are not listed as ingredients.

Selected food sources of MUFA with serving sizes (listed highest to lowest MUFA content)

Oils
(serving size is 1 teaspoon)

Nuts (serving size)

Seeds (serving size)

Butters (serving size)

Other (serving size)

Olive oil

Canola oil

Peanut oil

Sesame oil

Walnut oil

Soybean oil

Flaxseed oil (should be consumed raw and not used in cooking)

Grape seed oil

Macadamias (2-3)

Hazelnuts (5)

Pecans (5 halves)

Almonds (7)

Cashews (6)

Pistachios (17)

Brazil nuts (2)

Peanuts (9)

Pine nuts (50)

Walnuts (4 halves)

Sesame seeds
(1 Tbsp)

Pumpkin seeds
(47 seeds)

Ground flaxseed
(1 Tbsp)

Sunflower seeds
(3 Tbsp)

Almond butter
(½ Tbsp)

Cashew butter
(½ Tbsp)

Peanut butter (½ Tbsp)

Tahini/sesame paste (2 tsp)

Sunflower seed butter (2 tsp)

Avocado
(2 Tbsp or 1 oz)

Black olives(8)

Green olives (10)

Selected Plant Sources of Omega-3 Fatty Acids (listed highest to lowest omega-3 content)
Please visit the Fish & Seafood sections for more information about animal sources of omega-3 fatty acids.

Oils (serving size = 1 teaspoon)	Nuts and seeds (serving size)
Flaxseed oil*	Flaxseeds (1 Tbsp)
Walnut oil	Walnuts (4 halves)
Canola oil	Pecans (5 halves)
Soybean oil	Pine nuts (50)
*Should be consumed raw and not used in cooking.

Specific Considerations

Calorie-controlled high-MUFA diets:

Do not promote weight gain
Are more suitable than low-fat diets for weight loss in obese people
Are a substitute for low-fat diets for medical nutrition therapy in diabetes

Flaxseed Facts

Flaxseeds are an oilseed just like canola and sunflower are oilseeds. The seeds that come from flax provide excellent health benefits:

Rich source of omega-3 fatty acids, which are similar to the healthy fats found in fatty fish such as salmon
Good source of fiber
Contain other beneficial plant nutrients called lignans; research shows that a diet that contains lignans may reduce the risk of several types of cancer as well as heart disease and osteoporosis
Using ground flax meal or grinding flaxseeds in a coffee grinder is necessary to make MUFA available to our bodies.

What is the daily recommended intake of omega-3 fatty acids?

There are currently no established guidelines regarding optimal omega-3 intake. According to the Institute of Medicine, the Adequate Intake (AI) is 1.1g daily for women and 1.6 g daily for men. However, some experts believe that these recommendations might be too low to obtain the health benefits associated with omega-3s. Research shows benefits associated with higher intake of 2-3 g per day.

Why is the fat ratio important?

Two types of fatty acids that are essential for human health are omega-3 and omega-6. Studies suggest that decreasing the ratio of omega-6 (in vegetable oils) to omega-3 fatty acids (in fatty fish and some vegetable oils) is important to reduce risk of cancer and heart disease, inflammatory conditions, and depression.

Most people consume too many omega-6 fatty acids and consume too little omega-3 fatty acids. To reduce your risk of chronic disease, reduce your intake of omega-6 fatty acids and increase your intake of omega-3 fatty acids.

Avoid vegetable oils such as corn or safflower oil.
Eliminate highly processed foods.
Eat high omega-3 fish at least twice per week.

Know Your Limits for Fat

On a 2,000 calorie diet, about 30% or 600 calories (67g) should come from total fat per day
A ratio of 1:2:1 of saturated to monounsaturated to polyunsaturated (such as omega-3s) fat is recommended
1:2:1 in calories equals 150:300:150; no more than 150 calories or 7.5% (17g) of total calories from saturated fat
Most people consume too much saturated fat and not enough monounsaturated or omega-3 fatty acids.

Ideas to balance your fat consumption

Choose salad dressings that use olive, canola, or flaxseed oils as its base.
Add avocados, nuts, or olives to salads instead of high saturated fat animal foods like cheese, butter and meat.
For a snack, opt for a small handful of nuts/seeds each day in place of highly processed and high fat choices including chips, pastries, and cookies.
Use olive and canola oils for most cooking.
To increase plant sources of omega-3s, choose walnuts, ground flaxseed and uncooked flaxseed oil.
Never use oils, seeds or nuts after they begin to smell or taste rank or bitter. This is a sign that the oil has begun to turn rancid through a harmful oxidation process.
For high temperature sautéing or frying, use oils with a high smoke point, like canola or grape seed oils.
Limit/avoid consuming:
- Polyunsaturated vegetable oils like safflower, sunflower and corn oil
- Margarine, vegetable shortening, and all products made with partially hydrogenated oils
- Saturated vegetable oils such as coconut, palm kernel and palm oil
Use high-quality cold-pressed olive oil, flaxseed oil or sesame oil as an addition to cooked foods or salads before eating.
Add a tablespoon or two of ground flax seeds or flax meal to smoothies, muffins, bread or any other home-made baked item.
Choose white meat; in general, red meat (fatty beef, lamb, pork, ham, duck, and goose) has more saturated fat than white meat (turkey or chicken without skin) or fish
Be aware of any foods deep fried in restaurants. Deep fried foods may say “fried in vegetable oil”, but it is often hydrogenated vegetable oil.

Fish and Sea Food

This Facts About lists common fish & seafood with an emphasis on those choices with high omega-3 content. We make recommendations on how to avoid toxins and choose fish & seafood that support sustainable fisheries. We provide a guide for selecting appropriate portion sizes and recommendations for incorporating healthy choices into your diet.

What are the recommended servings of fish & seafood?

Optional: 2-4 servings per week, including at least 2 servings of fish with high omega-3 content
- Serving size 4-6 ounces

Why should you choose fish & seafood?

Low in saturated fat
Rich source of protein and iron
Contains B-12 vitamins
Richest source of omega-3 fatty acids may be helpful in the prevention and treatment of: heart disease, high blood pressure, inflammation, mental health disorders, diabetes, digestive disorders, autoimmune disease, and cancer

Selected Food Sources with Serving Size*

Selected Fish and their Omega-3 Fatty Acid Content (2.0 g and above per serving)

Finfish High in Omega-3s	Average grams of omega-3 fatty acids per 6 ounce portion
Anchovy, European, canned in oil	3.4 g
Wild Salmon	3.2 g
Pacific and Jack mackerel	3.2 g
Sable Fish	3.0 g
Whitefish	3.0 g
Pacific sardine	2.8 g
Bluefin tuna	2.8 g
Atlantic herring	2.4 g
Atlantic mackerel	2.0 g
Rainbow trout	2.0 g
Note: We recommend eating fish listed in this table at least twice per week*

Selected Fish and Seafood with Moderate-Low Omega-3 Fatty Acid Content (less than 2.0 g per serving)

Common Finfish	Grams of Omega-3's per 6 oz. portion	Common Seafood	Grams of Omega-3's per 6 oz. portion
Tuna, white albacore, canned in water	1.4 g	Mussel	1.4 g
Halibut	0.8 g	Wild Eastern Oyster	1.0 g
Pollock	0.8 g	Farmed Eastern Oyster	0.8 g
Ocean Perch	0.4 g	Blue crab or Alaska King crab	0.8 g
Tuna, light, canned in water	0.4 g	Shrimp	0.6 g
Yellowfin tuna	0.4 g	Scallop	0.6 g
Cod	0.2 g	Clam	0.4 g
.	.	Lobster	0.2 g
.	.	Crayfish	0.2 g
*Note: While the fish and seafood above do contain some omega-3s, other fish are richer sources (see High Omega-3 table above)*

* Omega-3 content of various fish and seafood sources are averages and may depend on factors such as time of year of harvest and body of water in which the animal resides. Values should be used for comparison of relative amounts in fish and seafood sources of omega-3 fatty acids.

Special Considerations

Choosing Fish & Seafood

Seafood should not smell "fishy" but rather like a "fresh ocean breeze"
Mollusks should always be alive when purchased with the shells. Shells should be tightly closed or close tightly when gently tapped.
Use fresh fish no later than 2 days after purchase
For long-term storage, fish must be frozen
Fish is fully cooked when the flakes separate easily; about 10 minutes of cooking time per 1 inch of thickness

What are omega-3 fatty acids?

Omega-3 fatty acids are a type of polyunsaturated fatty acid (PUFA). They are an essential component of the human diet because our bodies can not make them. These fats are necessary for proper brain growth and development. Omega-3s are most abundant in deep-water fatty fish and some plant foods. They are anti-inflammatory and may be helpful in the prevention and treatment of numerous conditions.

Which fish should you eat to get the greatest benefits of omega-3 fatty acids?

Omega-3 fatty acid content varies greatly among different species of fish. Cold-water fatty fish have the highest content of omega-3 fatty acids because their physiology, environment and diet promote omega-3 fatty acid production in their flesh.
All fish contain some amount of omega-3s, however quantities vary among species and within a species according to the same factors mentioned above, i.e. environment and diet.

What is the daily recommended intake of omega-3 fatty acids?

There are currently no established guidelines regarding optimal omega-3 intake. According to the Institute of Medicine, the Adequate Intake (AI) is 1.1g daily for women and 1.6 g daily for men. Although some experts believe that these recommendations might be too low to obtain the health benefits associated with omega-3s. Research shows benefits associated with higher intake of 2-3 g per day.

Why is the fat ratio important?

Two types of fatty acids that are essential for human health are omega-3 and omega-6. Studies suggest that decreasing the ratio of omega-6 (in vegetable oils) to omega-3 fatty acids (in fatty fish) is important to reduce risk of cancer and heart disease, inflammatory conditions, and depression.

Avoid vegetable oils such as corn or safflower oil.
Eliminate highly processed foods.
Eat high omega-3 fish at least twice per week.

Know Your Limits for Fat

On a 2,000 calorie diet, about 30% or 600 calories (67g) should come from total fat per day
A ratio of 1:2:1 of saturated: monounsaturated: polyunsaturated (such as Omega-3s) fat is recommended
1:2:1 in calories equals 150:300:150; no more than 150 calories or 7.5% (17g) of total calories from saturated fat

Potential Chemical Contaminants

Risk of Mercury Poisoning

Mercury is a toxic heavy metal that can accumulate in fish. Eating fish with high levels of mercury can negatively impact brain development in children and can affect learning and memory function in adults. Certain fish species are known to have higher mercury concentrations than others, sometimes due to polluted waters. The highest levels of mercury and contaminants tend to accumulate in the large predatory fish at the top of the food chain.

Avoid in pregnancy and in young children*

Shark

Swordfish

King mackerel

Tilefish

Limit intake in children as well as pregnant and nursing women**

Albacore tuna
Bass (Sea and Largemouth)
Bluefish
Grouper
Halibut
Lobster
Marlin
Red snapper
Pike
Orange roughy
Spanish mackerel
Walleye

Low levels of mercury-containing fish**

Anchovies
Atlantic mackerel
Catfish
Cod
Canned light tuna
Haddock
Herring
Mahi mahi
Pollock
Salmon
Sardine
Shad
Shrimp
Trout
Whitefish

Advice from the EPA for women who are pregnant, planning to become pregnant or nursing:

*Do not eat shark, swordfish, king mackerel, or tile fish because they contain high levels of mercury. Everyone else can eat up to 6 ounces of high-mercury fish per week.
** Eat up to 12 ounces per week (about 3 to 4 servings) of a variety of fish and shellfish that are lower in mercury
Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.
A commonly eaten fish, albacore ("white") tuna contains higher levels of mercury than canned light tuna because these fish are larger. Limit consumption to 6 ounces of albacore tuna per week.
For further information about the safety of locally caught fish and shellfish, visit the Environmental Protection Agency's Fish Advisory website www.epa.gov/ost/fish or contact your State or Local Health Department. A list of state or local health department contacts is available at www.epa.gov/ost/fish. If no advice is available, eat up to 6 ounces per week of fish you caught from local waters, but don't consume any other fish during that week.
Follow these same recommendations when feeding fish and shellfish to your young children, but serve smaller portions

Risk of PCB Exposure

PCBs (polychlorinated biphenyls) are industrial pollutants that find their way into fresh waters and oceans where they are absorbed by fish. A recent study reported unacceptable levels of PCBs in fish feed given to farmed salmon. The study reported that PCB levels in farmed salmon, especially those in Europe, were about seven times higher than in wild salmon. PCBs are potential human carcinogens, known to promote cancer in animals. Other potential health effects include impaired memory and learning, and adverse effects on the immune, reproductive and nervous systems. Until more research results are available, it may be prudent to choose wild salmon over farmed salmon and eat a wide variety of fish, along with plant sources of omega-3s. You can reduce PCB exposure from fish by removing the skin and visible fat as well as baking, broiling or grilling fish instead of frying.

Farmed vs. Wild

The old adage “you are what you eat” applies even if you are a fish. The location and living conditions where fish and seafood live can affect what they eat and their exposure to chemicals. In some studies, farm-raised fish have been shown to contain higher levels of contaminants compared to fish caught from the wild. However, there are some ethical fish farms that take good care of their fish and limit contaminant exposure. Recommendations have not yet been established for farmed vs. wild fish and seafood sources although the EPA has limited fish consumption in vulnerable populations such as children and women of childbearing age. Talk to the person you buy your fish and seafood from to better understand this issue.

Incorporating High Omega-3 Fish into Your Diet

Order a variety of fish in restaurants and avoid fish that is fried or dipped in batter.
Experiment with fish recipes to replace red meat and other high fat choices.
Look for wild salmon at your local health food stores.
Mix canned sardines with your own combination of chopped red onion, avocado, hard-cooked eggs, lemon juice, salt and/or pepper.
Add chopped anchovies to pasta sauce just after you sauté your onions and garlic; the fish will melt away while leaving a mild, subtle fishy taste to your sauce.
When buying canned products, look for fish packed in water or olive oil (preferably, extra-virgin).
Cook with either dry or moist heat methods; poached, steamed, grilled, baked, or broiled are preferred.
Avoid fish that is battered and fried, slathered in butter, or blanketed in creamy sauces to reduce saturated fat and calorie intake.

Lean Meats

This Facts About reviews lean meats and gives examples of foods to choose from as well as foods to avoid. We provide a guide for selecting an appropriate portion size and recommendations for incorporating healthy changes into your diet.

What are the recommended servings per week?

Optional* : 1-3 servings per week

*Optional - Those individuals choosing to not include animal foods in their diet need to be aware of important nutrients found in these foods. These nutrients can be obtained from a thoughtful and varied vegetarian diet. However, some individuals who avoid animal products may develop a vitamin B12 or iron deficiency and may also need to consider a calcium supplement. If you have questions regarding this, consult with your physician or registered dietitian regarding your individual needs.

Why choose lean meat?

High protein source
Rich iron source
Contains B-12 vitamins

Selected Food Sources with Serving Sizes

Selected Lean Meat Sources Lean Meat Portion size: 2-3 oz
Poultry	Beef	Pork	Lamb	Wild Game
Chicken	Flank steak	Centerloin	Chops	Venison
Cornish hen	Sirloin tip	Tenderloin	Leg roast	Bison
Turkey	Eye of Round	Canadian bacon	Tenderloin Shank	Elk
White meat, but not dark meat, without skin is considered lean.	Top Round			Ostrich
	Tenderloin			Emu
	Top Loin			Squab
	Rump roast			Wild duck
	Extra lean ground beef			Pheasant
	Extra lean ground beef			Rabbit

Special Considerations?

Choosing lean meats

Choose lean meat containing less than 3g of fat per 1 oz
Generally, the leanest cuts of meat contain round or loin in their name
Choose animal products that are labeled “organic,” “hormone-free,” “antibiotic-free,” “free-range,” “grass-fed, “ and / or “wild” whenever possible
Choose lean meat over higher fat choices to reduce total fat intake
Consume lean meat weekly rather than daily
Look for poultry with USDA Select grading of A and B
Look for beef with USDA Select or Choice grading
To lower the fat content of poultry and other meat, cut off skin and fat before cooking and/or eating it
While many grocery stores carry both ground chicken and ground turkey, it may contain as much fat as ground beef because it may include dark meat and skin. For lower fat, choose ground breast meat or look for low fat ground chicken or turkey.

Saturated Fat Content

Lean meat contains less than 3g of fat per 1 oz , which is less than higher fat choices, but still contains some saturated fat
The typical American diet is high in saturated fat, coming mostly from animal foods
Eating too many foods with saturated fat may increase blood levels of LDL and total cholesterol. High blood levels of LDL and total cholesterol are risk factors for heart disease.
Diets high in saturated fat promote obesity, cancer, heart disease, inflammatory arthritis, diabetes, and chronic pain

Use of Hormones and Antibiotics

Most commercial animal products contain residues from drugs, hormones, and chemicals used to keep modern dairy cows producing abundantly. These residues in food may increase the risk of breast cancer and other hormone-related cancers including prostate cancer.
Most commercially-raised animals may have been exposed to antibiotics. This practice contributes to the escalating problem of antibiotic-resistant bacteria throughout the world.

Choose Organic

We recommend organic, free-range animal products because they contain less antibiotic or hormone residue and have a higher omega-3 and vitamin E content. These qualities make organic animal products a better nutritional choice. We believe they generally provide better flavor than conventionally raised animals.

Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations. Organic meat, poultry, eggs, and dairy products come from animals that are given no antibiotics or growth hormones. Organic food is produced without using most conventional pesticides, petroleum-based fertilizers, or sewage sludge-based fertilizers, bio-engineering, or ionizing radiation. Organic systems replenish and maintain soil fertility, eliminate the use of toxic and persistent pesticides and fertilizers, and build biologically diverse agriculture.

Free-Range, Grass-fed, Pasture-raised

Some studies have shown that free-range, grass-fed and pasture-raised animals contain more omega-3 fatty acids and vitamin E. Free-range farming generally provides adequate room inside. To be certified by the USDA, producers must demonstrate to the Agency that the animal has been allowed access to the outside. These animals have fresh air, open space, and enjoy shelter. They also have the opportunity to forage for food.

Know Your Limits for Fat

On a 2,000 calorie diet, about 30% or 600 calories (67g) should come from total fat per day
A ratio of 1:2:1 of saturated: monounsaturated: polyunsaturated (such as Omega-3s) fat is recommended
1:2:1 in calories equals 150:300:150; no more than 150 calories or 7.5% (17g) of total calories from saturated fat

Ideas for your lean meat consumption

When ordering lean meat in restaurants make sure that it has been prepared with either dry or moist heat methods; poached, steamed, grilled, baked or broiled are preferred.
To reduce saturated fat and calorie intake, avoid meat that has been battered and fried, slathered in butter, or blanketed in creamy sauces.
Experiment with leaner cuts of meat in your favorite recipes to replace higher fat choices.
Choose lean meat up to 3 times per week rather than daily.
Use lean meat to flavor meals rather than as the main focus.
Be mindful of portion size for all meats – a 2-3 oz serving of lean meat is approximately the size of a deck of cards
To reduce the amount of meat in a recipe, replace half with beans, mushrooms or other vegetables.

Alcohol

This Facts About reviews the benefits and risks of alcohol consumption. It also provides a guide for selecting appropriate amounts.

What are the recommended servings per day?

Optional: 1-2 servings per day depending on age, gender, and history

Optional - Although there are some documented health benefits to moderate alcohol consumption, we do not encourage people to start drinking. As with other categories listed in this pyramid, there are potential health risks that must be weighed (see health concerns section).

What is moderate drinking?

One drink or less a day for women and people over 60
Two drinks or less a day for men (no more than one an hour)

This limit is based on the differences between men and women both in weight and the way they metabolize alcohol.

Is the risk-benefit balance for an individual drinker favorable or unfavorable?

Risk-benefit balance depends on the individual's age, gender, and history. We do not recommend alcohol consumption for:

Women who are pregnant or planning to become pregnant
People who plan to drive or engage in other activities that require attention or skill
People taking medications that interact with alcohol, including some over-the-counter medications
Individuals with a history of alcoholism or alcohol abuse
Those under the age of 21

Selected Alcohol Beverage Sources with Serving Sizes

Type of Drink	Serving Size	Typical % Alcohol	Total Amount of Alcohol
Beer	12 oz.	5 %	0.6 oz.
Wine	5 oz.	12 %	0.6 oz.
Hard liquor (whiskey, vodka, rum, gin, scotch)	1.5 oz.	40 %	0.6 oz.
The alcohol content of a beverage is dependent on its alcohol concentration, or % alcohol. The above examples contain approximately the same amount of alcohol.

What are the potential health benefits of moderate alcohol consumption?

May lower risk of coronary artery disease and heart attack
May decrease risk of stroke caused by blocked blood vessels
Decreases tension, anxiety, and self-consciousness
In the elderly, stimulates appetite and may promote regular bowel movement
May be associated with a decreased risk of gall bladder surgery in women

Red Wine

Moderate consumption may be associated with longevity
Contains tannins, which may raise HDL (good) cholesterol levels and inhibit platelet cells in the blood from clumping together
Contains resveratrol, an antioxidant compound found in grapes, which may decrease the development of some cancers
Resveratrol affects the immune system and inflammation in the body; both immune and inflammatory components are thought to be important in the development of plaque buildup in blood vessels, which often leads to heart disease
Significant source of saponins, antioxidants believed to promote heart health by binding to cholesterol in the blood and preventing its absorption
Saponins may play a role in decreasing inflammation, which could have beneficial effects in reducing heart disease and cancer risks

Liquor and Beer

Raises HDL (good) cholesterol levels
Inhibits platelet cells in the blood from clumping together

What are the health concerns of alcohol consumption?

Increases risk of accidents
Often a trigger for migraine headaches
Increases strokes caused by bleeding
Higher risk of fetal alcohol effect (FAE), low birth weight, and stillbirth
Increases physical, mental, and behavioral problems among the children of mothers who drink during pregnancy
Medication interactions - including non-prescription drugs
Increases the risk for cancers of the oral cavity, pharynx, esophagus, and larynx
Increases the risk for cancers of the stomach, colon, rectum, liver, and ovaries
Increases accumulation of fat in the liver, alcoholic hepatitis, and cirrhosis. This contributes to liver disease and sometimes liver failure.
Increases estrogen levels, a risk for breast cancer
Tobacco use enhances alcohol's effects on the risk for cancers of the upper digestive and respiratory tract
Liquor consumption (not beer or wine) may be associated with higher homocysteine levels in the blood which is associated with an increased risk of heart disease

Specific Considerations

Abstinent individuals should not begin to drink solely for health benefits
Some benefits can be achieved from whole foods instead of alcohol. Resveratrol contained in grape skins is available in whole grapes, grape juice or wine.
Ask your physician about potential benefit and harm of alcohol consumption in your individual case, considering your age, gender, medical history, and medications

Take a Second

yasimk@gmail.com (Yasim) — Fri, 11 Apr 2008 11:47:00 +0000

Take a Second (Excerpts from toolstolife)

While we are postponing, life speeds by.
-Lucius Seneca (3BC–65AD)

Are you really telling me you don’t have a second? Come on, it’s me you’re talking to. Remember the rule: “I will not lie to myself.” Remember too, you’re training yourself to hear your inner voice. Out loud. Ready? Here we go: “Yes, I have a second.” That’s all it takes to improve the quality of your life. A second here, a second there.

You've trained yourself to be lazy. You trained yourself to ignore your inner voice. Now, as with everything else, we will use the Tools to stop being lazy. We will use these Tools to improve the quality of our everyday life. What’s funny is that, by taking a second, you will add time, not take time away, from your every day. You will feel lighter and happier overall. Hey, I can hear you! Be patient. I always tell you what I’m talking about, can’t you give me a second for my build up?

You’re already taking two to ten minutes a day, and now you will take a second as well. Let’s start easy. Your keys. How much time goes into looking for your keys? How come, when you come in through the door, you don’t take a second? How come you end up putting your keys anywhere and then have to take time and frustrate yourself looking for them? Then you feel late and pressured and annoyed before you even get to the door.

That’s not starting your day or any other time in the right frame of mind. Here’s what we will do. I like hooks for keys, but you pick. You find a place, a location where you’re going to put your keys. You will put them there every time you walk in the door. You will take that second and put the keys there. Again: you’re going to put the keys there. Take the second and make a mental note. Remember, Train Your Brain. Your inner voice will take care of it, and soon you’ll automatically put the keys there. Imagine no more looking for the keys. No more frustration! No more leaving the house feeling hassled. So take a second!

Action may not always bring happiness, but there is
no happiness without action.
-Benjamin Disraeli

Let’s hit some more easy ones:

(a) Put the cap right back on the toothpaste.

(b) Hey guys, put the toilet seat down.

(c) Put your CDs away! Again, this takes only a few seconds. You paid good money for them. You enjoy them. You want to be able to find them. You don’t want them scratched. You don’t want to fight with anyone who lives with you. Hey, it just takes a few seconds. You spend a lot more time going through the pile looking for them, than putting them away.

(d) Make your bed when you’re finished dressing. It takes a second. You’ll feel better about yourself. It’s nice to come home to a made bed. You actually function better at work or school knowing your bed is made. It builds self-esteem.

(e) Before you go to bed, put your clothes in the hamper, or hang them up.

(f) Do the dishes when you finish eating. Old dishes take longer to clean. Take a second and do them. I bet most of you have a dishwasher. How tough is it to put them in? Again, having a clean house builds self-esteem, and you perform better. Remember, we want all the odds on your side. Don’t lie to yourself; you have the time. You will spend less time by taking those seconds.

First say to yourself what you would be; and then do what you have to. -Epictetus

There are so many more examples I can give, so take a sec', and do the things you should. Life is not as tough as we make it on ourselves—from how to study to how to keep house to how to live. For now I would like to end with what will only take you a second. Ready? “TAKE A SEC'.”

So every time your inner voice says, “Do it now,” and your out-loud voice says, “I’ll do it later,” you do it now. You’re going to develop the habit of paying attention to your inner voice and doing the things you know you should, right there and then. No lost bills, no failing to find things or coming home to a mess. You’ll find your mind will function clearer and quicker without all these little things piling up and without constantly frustrating yourself.

I have always found that we are our own best friends and our own worse enemies. We can be both or just one. You can give yourself an edge out there.
Build your self-esteem, build positive habits and be successful. Everything builds
on itself. The better you feel, the better you can take advantage of life’s opportunities. The better you feel, the more positive momentum you have behind you.

It’s funny, but a simple thing like making your bed or leaving a clean sink gives you strength. Remember, the brain is a sponge and functions on many different levels. Your brain knows that you didn’t pay the bills even if you’re not thinking about them. Your brain knows that you’re coming home to a mess, even if you’re not thinking about it. Besides, you can’t invite someone over on the spur of the moment, and you never know what you might be missing. Seriously folks, your brain knows, and all the little things you don’t take a second for clutter your brain, and when you’re out there in the real world, you might be a split second behind the ball because of it. Your brain might wander, and one of those things you didn’t take a second for might take over right when you need to be paying attention to what’s going on. Just like when you’re driving and hit the car in front of you because your mind drifted for that split second.

Listen, we’re here to get all the odds in our favor, and all these little seconds end up costing not only more time; they also cost you peace of mind, whether you realize it or not. So we’re going to take a second. Remember, every time you say “later,” do it now. Pick a spot for your keys, pay attention to yourself when you come in through the door and take a second to put your keys there every time. Remember the inner voice that says not to lie to yourself. You know you can do it, and today we’re making the decision to do it.

Early Prostate Cancer: Questions and Answers

yasimk@gmail.com (Yasim) — Wed, 09 Apr 2008 01:33:00 +0000

Early Prostate Cancer: Questions and Answers

Key Points

* The prostate is a gland in the male reproductive system that makes and stores a component of semen (see Question 1).
* The most common risk factor for prostate cancer is age (see Question 3).
* Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate (see Question 4).
* The symptoms of prostate cancer can also be caused by noncancerous conditions (see Questions 4 and 5).
* Two tests can be used to detect prostate cancer in the absence of any symptoms: a digital rectal exam and a blood test to detect a substance made by the prostate called prostate-specific antigen (PSA) (see Questions 6 and 7).
* The diagnosis of prostate cancer can be confirmed only by a biopsy (see Question 8).
* Prostate cancer is described by both grade and stage (see Question 8).
* Three treatment options are generally accepted for men with localized prostate cancer: radical prostatectomy, radiation therapy, and surveillance (also called watchful waiting) (see Questions 9, 10, and 11).

1. What is the prostate?

The prostate is a gland in the male reproductive system. The prostate makes and stores a component of semen and is located in the pelvis, under the bladder and in front of the rectum. The prostate surrounds part of the urethra, the tube that empties urine from the bladder. A healthy prostate is about the size of a walnut. Because of the prostate’s location, the flow of urine can be slowed or stopped if the prostate grows too large.

2. What is prostate cancer?

Prostate cancer forms in the tissues of the prostate. Except for skin cancer, cancer of the prostate is the most common malignancy in American men. It is estimated that 218,890 men in the United States will be diagnosed with prostate cancer in 2007 (1). In most men with prostate cancer, the disease grows very slowly. The majority of men with low-grade, early prostate cancer (which means that cancer cells have been found only in the prostate gland) live a long time after their diagnosis. Even without treatment, many of these men will not die of the prostate cancer, but rather will live with it until they eventually die of some other, unrelated cause. Nevertheless, it is estimated that nearly 27,000 men will die from prostate cancer in 2007 (1).

3. Who is at risk for prostate cancer?

An important risk factor is age; more than 70 percent of men diagnosed with this disease are over the age of 65. African American men have a substantially higher risk of prostate cancer than white men, including Hispanic men. Dramatic differences in the incidence of prostate cancer are also seen in different populations around the world. There is some evidence that dietary factors are involved, such as vitamin E and selenium, which may have a protective effect. Genetic factors also appear to play a role, particularly for families in which the diagnosis is made in men under age 60. The risk of prostate cancer rises with the number of close relatives who have the disease.

4. What are the symptoms of prostate cancer?

Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include:
* Urinary problems:
o Not being able to urinate.
o Having a hard time starting or stopping the urine flow.
o Needing to urinate often, especially at night.
o Weak flow of urine.
o Urine flow that starts and stops.
o Pain or burning during urination.
* Difficulty having an erection.
* Blood in the urine or semen.
* Frequent pain in the lower back, hips, or upper thighs.

These can be symptoms of cancer, but more often they are symptoms of noncancerous conditions. It is important to check with a doctor.

5. What other prostate conditions can cause symptoms like these?

As men get older, their prostate may grow bigger and block the flow of urine or interfere with sexual function. This common condition, called benign prostatic hyperplasia (BPH), is not cancer, but can cause many of the same symptoms as prostate cancer. Although BPH may not be a threat to life, it may require treatment with medicine or surgery to relieve symptoms. An infection or inflammation of the prostate, called prostatitis, may also cause many of the same symptoms as prostate cancer. Again, it is important to check with a doctor.

6. Can prostate cancer be found before a man has symptoms?

Yes. Two tests can be used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate-specific antigen (PSA). Together, these tests can detect many "silent" prostate cancers that have not caused symptoms. Due to the widespread implementation of PSA testing in the United States, approximately 90 percent of all prostate cancers are currently diagnosed at an early stage, and, consequently, men are surviving longer after diagnosis.

At present, however, it is not known whether routine prostate screening saves lives. Screening is a term used to describe tests when they are done in individuals who are not experiencing any symptoms. The benefits of screening and local therapy (surgery or radiation) remain unclear for many patients. Because of this uncertainty, the National Cancer Institute (NCI), a part of the National Institutes of Health, is currently supporting research to learn more about screening men for prostate cancer. Currently, researchers are conducting a large study to determine whether screening men using a blood test for PSA and a DRE can help reduce the death rate from this disease. They are also assessing the risks of screening. Full results from this study, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), are expected by 2015.

7. How reliable are the screening tests for prostate cancer?

Neither of the screening tests for prostate cancer is perfect. Most men with mildly elevated PSA levels do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. Also, the DRE can miss many prostate cancers. The DRE and PSA test together are better than either test alone in detecting prostate cancer.

A recent study examining the PSA histories of men enrolled in the Baltimore Longitudinal Study of Aging (BLSA) suggests that PSA velocity may be a better indicator of potentially life-threatening cancer than PSA level. PSA velocity is the rate at which serum PSA levels change over time. The study found that men who had a PSA velocity above 0.35 ng/ml per year had a higher relative risk of dying from prostate cancer than men who had a PSA velocity less than 0.35 ng/ml per year (2). More studies are needed to determine if PSA velocity more accurately detects potentially life-threatening prostate cancer early.

The NCI Early Detection Research Network (EDRN) has a Prostate Collaborative Group, which is applying a variety of strategies to find better ways to detect prostate cancer early. In addition, the NCI’s prostate cancer Specialized Program of Research Excellence (SPORE) program is funding projects to identify new biomarkers to detect prostate cancer.

8. How is prostate cancer diagnosed?

The diagnosis of prostate cancer can be confirmed only by a biopsy. During a biopsy, a urologist (a doctor who specializes in diseases of urinary and sex organs in men, and urinary organs in women) removes tissue samples, usually with a needle. This is generally done in the doctor’s office with local anesthesia. Then a pathologist (a doctor who identifies diseases by studying tissues under a microscope) checks for cancer cells.

Men may have blood tests to see if the cancer has spread. Some men also may need the following imaging tests:
* Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film. The pictures may show cancer that has spread to the bones.

* CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body. Doctors often use CT scans to see the pelvis or abdomen .

* MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside the body.

Prostate cancer is described by both grade and stage.
* Grade describes how closely the tumor resembles normal prostate tissue. Based on the microscopic appearance of tumor tissue, pathologists may describe it as low-, medium-, or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. In both systems, the higher the score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors.

* Stage refers to the extent of the cancer. Early prostate cancer, stages I and II, is localized. It has not spread outside the gland. Stage III prostate cancer, often called locally advanced disease, extends outside the gland and may be in the seminal vesicles. Stage IV means the cancer has spread beyond the seminal vesicles to lymph nodes and/or to other tissues or organs.

9. How is localized prostate cancer treated?

Three treatment options are generally accepted for men with localized prostate cancer: radical prostatectomy, radiation therapy (with or without hormonal therapy), and surveillance (also called watchful waiting).
* Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection. However, nerve-sparing surgery is not always possible.

* Radiation therapy involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered in a technique known as brachytherapy, which involves implanting radioactive seeds in the prostate using a needle. Patients with high-risk prostate cancer are candidates for adding hormonal therapy to standard radiation therapy.

* Active Surveillance (watchful waiting) may be an option recommended for patients with early-stage prostate cancer, particularly those who have low-grade tumors with only a small amount of cancer seen in the biopsy specimen. These patients have regular examinations, PSA testing, and sometimes scheduled biopsies. If there is evidence of cancer growth, active treatment may be recommended. Older patients and those with serious medical problems may also be good candidates for active surveillance.

10. How does a patient decide what is the best treatment option for localized prostate cancer?

Choosing a treatment option involves the patient, his family, and one or more doctors. They will need to consider the grade and stage of the cancer, the man’s age and health, and his values and feelings about the potential benefits and harm of each treatment option. Since both surgery and radiation therapy are options for localized disease, consultation with both a urologist and a radiation oncologist is recommended. Often it is useful to seek additional opinions—from the same type of doctor, an internist, a family practice physician, or a medical oncologist. Because there are several reasonable options for most patients, patients may hear different opinions and recommendations and the decision can be difficult. However, patients should try to get as much information as possible and allow themselves enough time to make a decision. There is rarely a need to make a decision without taking time to discuss and understand the pros and cons of the various approaches.

11. Where can a person find more information about prostate cancer and its treatment?

The NCI has several other resources that readers may find helpful, including the following:

* The Prostate Cancer home page provides links to NCI resources about prevention, screening, treatment, clinical trials, and supportive care for this type of cancer. This page can be found on the NCI’s Web site at http://www.cancer.gov/cancertopics/types/prostate on the Internet.

* Prostate Cancer (PDQ®): Treatment includes information about prostate cancer treatment, including surgery, chemotherapy, radiation therapy, and hormone therapy. This summary of information from PDQ, the NCI’s comprehensive cancer information database, is available at http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient/ on the Internet.

* Treatment Choices for Men With Early-Stage Prostate Cancer describes the treatment choices available to men diagnosed with early-stage prostate cancer and examines the pros and cons of each treatment. This NCI fact sheet is available at http://www.cancer.gov/cancertopics/prostate-cancer-treatment-choices on the Internet.

Selected References

1. Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute, 2007.

2. Carter HB, Ferrucci L, Kettermann A, et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. Journal of the National Cancer Institute 2006; 98(21):1521–1527.

###

Related NCI materials and Web pages:

* National Cancer Institute Fact Sheet 5.29, The Prostate-Specific Antigen (PSA) Test: Questions and Answers
(http://www.cancer.gov/cancertopics/factsheet/Detection/PSA)
* Treatment Choices for Men With Early-Stage Prostate Cancer
(http://www.cancer.gov/cancertopics/prostate-cancer-treatment-choices)
* Understanding Prostate Changes: A Health Guide for Men
(http://www.cancer.gov/cancertopics/understanding-prostate-changes)
* What You Need To Know About™ Prostate Cancer
* (http://www.cancer.gov/cancertopics/wyntk/prostate)
* Prostate Cancer Home Page
(http://www.cancer.gov/cancertopics/types/prostate)

NCCN Prostate Cancer Notes

yasimk@gmail.com (Yasim) — Wed, 09 Apr 2008 00:59:00 +0000

Clink on the above link for more notes

Management of Bone Metastases in Patients With Prostate Cancer

yasimk@gmail.com (Yasim) — Sat, 05 Apr 2008 17:56:00 +0000

Introduction

Over 80% of patients with advanced prostate cancer are affected by bone metastasis, an incurable progression of the disease that accounts for a vast majority of disease-related mortality and is associated with significant morbidity. In addition, androgen deprivation therapy (ADT), the mainstay of treatment for advanced prostate cancer, increases fracture risk and may contribute to skeletal morbidity. The combination of these factors makes bone metastases one of the most wide-reaching and difficult processes to address in patients with prostate cancer.

Because the precise molecular and cellular mechanisms of the metastatic process in prostate cancer are still poorly understood, there remains an unmet need for effective strategies to prevent the progression of disease or, at the very least, to diminish the likelihood for development of additional metastases. Among the various, mostly palliative, treatments used to treat bone metastases, bone-targeted approaches using bisphosphonates, radiopharmaceuticals, or endothelin receptor antagonists currently appear to offer the most promise in terms of efficacy and tolerability.

This chapter of the Report to the Nation on Prostate Cancer will review the best-understood mechanisms behind the development of bone metastases and the latest research in the use of agents to combat the progression of and the complications associated with bone metastatic prostate cancer.

Mechanisms of Bone Metastasis

Bone metastases in patients with breast cancer and multiple myeloma are predominantly osteolytic in nature. By contrast, prostate bone lesions are mixed, containing both osteolytic and osteoblastic elements. Under normal conditions, the rates of bone formation and bone resorption are balanced. In patients with prostate cancer, however, the increase in osteoblast number and activity, coupled with an increase in osteoclastic activity adjacent to the osteoblastic lesions,^[10,11] leads to an imbalance in remodeling and to more brittle bone tissue. Of note, urinary deoxypyridinoline, a marker of osteoclastic activity, has been shown to predict skeletal complications in patients with androgen-independent bone metastatic disease,^[ indicating that bone resorption can directly affect clinical outcomes.

Transforming growth factor-beta (TGF-beta), epidermal growth factor (EGF), and other bone-derived growth factors that promote prostate cancer cell growth and differentiation have been shown to influence the preferential localization of prostate cancer in bone tissue. TGF-beta, which is expressed by prostate cancer cells and plays a role in osteoclastic maturation, facilitates cellular adhesion to the bone matrix, which, in turn, influences expression of androgen-independent cellular growth. Similarly, by promoting migration of prostate cancer cells to bone tissue, EGF facilitates development of metastases in bone.

Other tumor-derived factors that have been shown to influence development of bone metastases include endothelin-1, osteoprotegerin, bone morphogenic protein, and insulin-like growth factor. Discussion of their respective roles in the pathogenesis of bone metastases and of their potential utility as therapeutic targets is presented below.

The primary mechanisms of bone metastasis development in prostate cancer are illustrated in the Figure.

Figure. Interaction between tumor cells and bone in patients with bone metastatic prostate cancer.

TGFβ = transforming growth factor-beta; IGF = insulin-like growth factor; ET-1 = endothelin-1; BMPs = bone morphogenic proteins; OPG = osteoprotegerin; EGF = epidermal growth factor; bFGF = basic fibroblast growth factor.

Detection of Prostate Bone Metastases
Bone scintigraphy, or conventional bone scan, with Tc-99m MDP radiotracer is the current standard of care for detection of bone metastases. With this method, the entire skeleton is imaged, and uptake of the tracer is mediated by osteoblastic activity rather than the tumor itself. Bone scans are very sensitive, but not specific; other processes are associated with increased tracer accumulation in bone, including trauma, infection, and degenerative joint disease such as arthritis.
Studies with magnetic resonance imaging (MRI) indicate improved efficacy over bone scintigraphy due to its ability to detect metastatic cellular foci (ie, fatty and cellular tissue elements of bone marrow) before cortical bone destruction has occurred.In a series of 36 prostate cancer patients, MRI showed to be particularly useful in clarifying inconclusive radiographic tests in prostate cancer. Of 19 positive bone scans in 36 patients, MRI confirmed 8 equivocal cases and demonstrated additional metastatic lesions in 6 patients. MRI also indicated areas of spinal compression in 5 patients with spinal metastases, and altered the clinical stage in 2 patients. Only 1 false positive was noted. Results from a second trial in 19 men with prostate cancer concurred: Detection of metastatic disease was seen in 7% (1/13) of patients with a negative bone scan, and in 2 of 4 patients with indeterminate bone scans. Again, only 1 false positive was reported.
Given its demonstrable sensitivity over bone scintigraphy, MRI might also play a role in initial staging. In a retrospective review of staging skeletal scintigraphs in 200 patients with breast or prostate cancer, researchers determined that 7 of 100 breast cancer patients and 9 of 100 prostate cancer patients would be expected to have a negative MRI and abnormal bone scintigraphy. However, in the breast cancer patients, 1 of 7 abnormal scans represented metastatic disease, while in prostate cancer patients, only 1 of 3 represented metastatic disease. In addition, the high cost and difficulty in scanning all areas of interest limit the routine use of MRI. Thus, although data suggest that the addition of MRI to scintigraphy in initial staging may provide a more accurate basis for patient management, further study of MRI in this setting is clearly needed.
Because of its ability to detect tumors on the basis of metabolic activity rather than by simply demonstrating increased bone mineralization, the use of fluorine-18-deoxyglucose positron emission tomography (FDG-PET) has been examined as an alternative to bone scintigraphy. However, although it has proven effective in detecting other solid tumors, results in prostate cancer have been disappointing, possibly because prostate cancer tends to be metabolically quiescent. In one study, the technique underestimated the extent of osseous metastatic lesions in 4 of 5 patients, while in another it missed many of the osseous lesions found by bone scans.
By contrast, the use of 18-fluoride (18-F) as a tracer has shown greater promise. Early studies showed it to be more sensitive than bone scintigraphy, detecting twice as many prostate metastases in patients with established disease. Upon evaluation of patients with known metastatic lung cancer, two studies demonstrated that 18-F PET was more accurate and resulted in fewer false negatives compared with both bone scintigraphy and single photon emission computed tomography (SPECT). In a study of 26 patients with solid tumors and bone metastases, the integration of PET and computed tomography (CT) using the 18-F tracer had a 100% sensitivity and an 88% specificity vs 88% and 56%, respectively, with PET alone. Because these techniques are more expensive than the standard bone scintigraphy, additional studies with larger patient populations will be needed to confirm the benefits of 18-F PET and/or 18-F PET/CT.
Management of Bone Metastases
Bisphosphonates, synthetic analogues of inorganic phosphate that affect human bone metabolism through direct and indirect actions on osteolysis, have emerged as a key therapeutic strategy in the management of bone disease. Although they have demonstrable efficacy in treating osteoporosis, Paget's disease of bone, and hypercalcemia of malignancy, and have also proven beneficial in treating skeletal complications and pain in breast cancer, their application in the management of advanced prostate cancer is expanding, with more research being conducted to fully understand the potential of these agents.
Bisphosphonates are believed to act through several mechanisms: inhibition of cancer cells that bind to the bone matrix; osteoclast apoptosis through competitive inhibition of ATP/ADP translocase;inhibition of osteoclast formation, migration, and bone resorption; and inhibition of matrix metalloproteinases (MMPs). Recent in vitro data also suggest that bisphosphonates might act directly on osteoblasts by promoting preosteoblastic cell growth and differentiation. Their use in stemming bone loss seen with ADT has been well described, and is discussed in a separate chapter.
Variations in the molecular structure of each bisphosphonate determine its affinity for the bone mineral surface and its relative potency. Because the ability of bisphosphonates to inhibit cancer cell adhesion to cortical and trabecular bone has been shown to predict clinical efficacy, it has been suggested that use of more potent agents might improve outcomes in the management of bone metastases.
Zoledronic Acid
Of the available bisphosphonates, the third-generation zoledronic acid is the most potent. Like other agents in this class, its effects are mediated primarily through osteoclast proliferation and apoptosis.
In one of the largest phase 3 clinical trials with zoledronic acid, 643 patients with asymptomatic or minimally symptomatic bone metastatic androgen-independent prostate cancer (AIPC) were randomized to placebo or to 4 mg or 8 mg of zoledronic acid once every 3 weeks. To minimize renal complications, the protocol was amended to administration of the infusion over 15 minutes rather than over 5 minutes, and the infusate volume was increased from 50 to 100 mL. In addition, patients in the 8-mg arm were switched to the 4-mg dosage.
At study end, after 15 months of follow-up, fewer patients enrolled on the 4-mg zoledronic acid arm vs the placebo arm experienced at least one skeletal complication (33.2% with zoledronic acid vs 44.2% with placebo; P = .021), and the time to the first occurrence of any skeletal complication was shorter with placebo (median time to first event not reached in 4-mg group with zoledronic acid vs 321 days with placebo; P = .011). The skeletal morbidity rate, calculated as the number of skeletal complications divided by the time at risk in years, was significantly lower with 4-mg zoledronic acid (.80 vs 1.49; P = .006).^[36] Significant reductions in biochemical markers of bone metabolism were also observed. The drug was well tolerated; the most commonly reported adverse events included fatigue, anemia, myalgia, fever, and lower-limb edema.
Updated results from this trial demonstrated continuing benefits at 24 months.^[37] The proportion of patients experiencing at least one skeletal complication remained significantly lower with 4-mg zoledronic acid over placebo (38% vs 49%; P = .028), as did the median time to first event (488 days vs 321 days; P = .009).A significant delay was noted in the median time to a second event in patients on the zoledronic acid arm (median not reached for 4-mg zoledronic acid vs 449 days for placebo; P = .006), and a 32% relative reduction was noted in the percentage of patients on the zoledronic acid arm experiencing a second event vs those on placebo (P = .017).^[38] Notably, a multiple-event analysis combining skeletal complication rate and timing suggested an overall 40% reduction in the risk for developing subsequent events with 4-mg zoledronic acid vs placebo (P = .011).
As a class, bisphosphonates have an analgesic effect on bone pain, which is often included as an endpoint in clinical studies on bone metastases. In this trial, although there was an increase in mean bone pain scores (as measured by the Bone Pain Inventory) from baseline in both treatment and control groups, bone pain was consistently lower in patients treated with zoledronic acid vs placebo at all time periods, reaching statistical significance at the 3-, 9-, 21-, and 24-month time points.
On the basis of results from this and other studies, zoledronic acid was approved for the management of bone metastases in patients with AIPC, and may be of particular value for patients at high risk for bone fractures or spinal cord compression.The effect of zoledronic acid on skeletal complications in patients with hormone-sensitive disease will be evaluated in the CALGB/CTSU 90202 trial that is currently recruiting patients. Additional studies are needed to assess the potential for bisphosphonates to prevent the development of bone metastases.
Pamidronate and Clodronate
Pamidronate disodium, a second-generation bisphosphonate, and clodronate, a first-generation bisphosphonate, are far less potent than zoledronic acid, and the evidence supporting the use of either agent in prostate bone metastases is less clear than that for zoledronic acid.
Pamidronate is approved in the United States for use in hypercalcemia of malignancy, as well as for the treatment of osteolytic bone metastases in patients with breast cancer and multiple myeloma.However, in patients with symptomatic bone metastatic AIPC, data from two trials pooled for analysis showed no significant benefit for pamidronate 90 mg every 3 weeks vs placebo. Of the 374 patients enrolled in the trials, no sustainable differences were noted between the two arms in the proportion of patients with a skeletal complication or in change from baseline in mobility at 9 weeks or at 27 weeks.^[41] Of the 301 patients assessable for pain at 9 weeks and 218 patients assessable at 27 weeks, Brief Pain Inventory scores declined only minimally from baseline and were comparable between the treatment and control groups. The only significant difference was noted in a subset of pamidronate patients with decreasing or stable analgesic use, in whom the mean decrease in pain scores was significantly greater than placebo at 9 weeks (P = .008 for worst pain; P = .011 for average pain), but not at 27 weeks.
Data with clodronate, which remains investigational in the United States, are even less promising. Of the 209 patients with symptomatic bone metastatic AIPC receiving mitoxantrone and prednisone, no significant differences were noted between the addition of clodronate 1500 mg every 3 weeks or placebo in the primary study endpoint of palliation, defined as a reduction of 2 points on the pain scale or a 50% reduction in analgesic intake.^[42] No differences were seen in other endpoints of median duration of response, progression-free survival, overall survival, and overall quality of life, although patients with more severe pain fared slightly better on subgroup analysis.
In patients with androgen-sensitive bone metastatic prostate cancer, investigators attempted to increase the dose of oral clodronate to more closely match that which would have been delivered intravenously. However, although the 2080-mg daily dose of clodronate resulted in a 21% reduction in the risk of symptomatic bone progression or prostate cancer death and a 20% reduction in the risk of death,^[43] clodronate treatment was associated with significantly greater risk for gastrointestinal problems, leading to dose modification in approximately one third of patients (hazard ratio, 181% increase; P < .0001). The high rate of gastrointestinal toxicities suggests that the increased dose strategy is not feasible, and that the use of clodronate and other oral bisphosphonates in patients with prostate cancer is unlikely to be effective in management of bone metastases.
Although subgroup analysis in this study demonstrated a significant decrease in the time to first symptomatic skeletal complication, suggesting that there might be a benefit toward initiating bisphosphonate therapy at an earlier time point in the management of bone metastatic AIPC. Results from a similarly designed study ultimately found no significant benefit with clodronate in preventing symptomatic bone metastases or in improving overall survival. Clinical trials with agents more potent than clodronate might be better able to address this hypothesis.
Radiopharmaceutical Therapies
For patients with symptomatic bone metastases in whom bisphosphonates confer only moderate effects, radiation-based solutions can provide some palliative benefit. The use of local radiation therapy in this population as a single modality is well documented, and has been shown to provide symptomatic relief within a few weeks of administration. However, this approach is limited to patients with few sites of disease; hemibody radiotherapy, which targets the lower half of the body with a single dose of radiation, has been used in patients with more widespread disease. Both of these approaches have demonstrated significant improvements in pain scores and significant delays in the development of new sites of pain.Nevertheless, their lack of specificity for tumor bone sites can damage normal tissue, and the severe gastrointestinal toxicity seen with hemibody radiotherapy make these treatment modalities less than optimal.
By contrast, radioisotopes preferentially accumulate in tumor bone sites, minimizing the local tissue damage caused by standard radiotherapy.Studies with strontium-89, the most widely used radioisotope, demonstrated equivalence to local radiotherapy or hemibody radiotherapy in pain relief and in progression-free survival and time to disease progression. Response rates are above 70%, although about 20% experience pain flares 1-2 weeks after therapy. When added to consolidation therapy with doxorubicin, strontium-89 also showed activity, significantly increasing median survival time from 16.8 months to 27.7 months.However, hematologic toxicity with strontium-89, mainly transient dose-dependent thrombocytopenia, is frequent, with reports of patients developing acute myeloid leukemia following therapy.
A recent phase 3 trial of samarium-153 also demonstrated positive results, but with fewer side effects. By study end, significant improvements in analgesic consumption and pain were seen with the radioisotope vs placebo; changes in visual analog pain scores correlated with opiate use in the treatment arm but not in the placebo arm. Of note, hematologic toxicity was mainly mild transient myelosuppression, with nadirs observed 3-4 weeks after initiation of therapy and with recovery to normal levels observed by week 8.
Research with rhenium-188-HEDP, a radioisotope with a shorter physical half-life than strontium-89, is promising.In a phase 2 study in patients with hormone-refractory metastatic disease, palliation was achieved in 60% of patients receiving one dose of the isotope and in 92% receiving two doses; no grade 3 or grade 4 hematologic toxicities were seen in either group.
Continued research with these agents will explore their role in preventing bone metastasis and slowing disease progression; further attempts to enhance the efficacy of radiation-based therapies in combination with bisphosphonates and chemotherapy are also being explored.

Conclusions
Despite therapy, the prognosis for men with prostate cancer who develop bone metastases is poor. On average, median survival is currently estimated to be 30-35 months. Hence, therapeutic strategies that move beyond palliation to prevention of disease progression and development of bone metastases are essential, both in terms of prolonging life and in improving the prospects for better quality of life with fewer skeletal complications.
Although practicing clinicians have some ability to determine which patients are at risk for the development and progression of bone metastatic prostate cancer, the ability to extrapolate information about cellular or molecular mechanisms that potentially contribute to the metastatic cascade to assist with management is not as clear-cut.
Fortunately, researchers continue to define novel targets through which the skeletal metastatic process might be inhibited or interrupted. Some of the most compelling advances in this regard have been bone-targeting strategies using bisphosphonates to reestablish bone homeostasis, and ET-A antagonists to delay tumor progression in bone. Nevertheless, continued research in this arena is of paramount importance, and future clinical trials directed at novel targets such as RANKL, MMP, and OPG, which are currently in experimental development, are eagerly awaited.
These and other key issues regarding patients with bone metastatic prostate cancer are summarized in Table 1.
Optimal management of bone metastatic prostate cancer ultimately relies on discovering a means by which to halt disease progression altogether. As described in Table 2, future research and improvements in clinical practice in this and other areas will greatly contribute to our understanding of bone metastatic prostate cancer. In the interim, the challenge remains to diagnose bone metastatic prostate cancer at its earliest stages and as precisely as possible, so that skeletal complications can be adequately addressed and overall quality of life can be improved.
Table 1. Management of Bone Metastases in Patients With Prostate Cancer: Summary
1 The cross-talk among tumor cells, osteoclasts, and osteoblasts in the development of bone metastatic prostate cancer results in an imbalance in remodeling and subsequent fragile skeletal bone tissue as well as increased tumor growth in cells that have colonized bone tissue.
2 BMPs and RANK/RANKL mediate osteogenic activity, thereby making them attractive targets for disruption of bone disease progression.
3 Bone scintigraphy with Tc-99m tracer remains the standard of care for detection of bone metastases. Preliminary results with MRI, 18-F PET, and 18-F PET/CT have shown promise in improving sensitivity and specificity.
4 Administration of radiopharmaceuticals, such as strontium-89, samarium-153, and rhenium-188-HEDP, has demonstrated improvements in palliation and less damage to normal tissue compared with local radiation or hemibody radiation.
5 The potent bisphosphonate zoledronic acid has demonstrated an ability to reduce skeletal complications. Ongoing studies will address the role of earlier therapy.
Table 2. Future Research and Practice Opportunities: Calls to Action
1 Develop practice guidelines for the use of bisphosphonates in men initiating androgen deprivation therapy to prevent disruptions in bone metabolism and slow progression to bone metastatic disease.
2 Promote early diagnosis of bone metastatic disease by increased screening and thorough evaluations of patients with prostate cancer.
3 Encourage study of combination therapy with investigational and approved bone-targeted agents to stem the progression of bone metastases.
4 Develop criteria for conducting clinical trials in patients with bone metastatic disease with cytostatic agents, including clinically meaningful endpoints.
5 Promote enrollment in clinical trials by urologists, radiation oncologists, medical oncologists, and patients at all stages of prostate canc

Medications of prostate cancer

yasimk@gmail.com (Yasim) — Sat, 05 Apr 2008 17:02:00 +0000

Calutide (Generic Casodex)

Bicalutamide is a man-made drug that is used in the treatment of prostate cancer. It is a type of hormonal therapy. Hormonal therapies interfere with the production or action of particular hormones in the body. Hormones are substances produced naturally in the body, where they act as chemical messengers and help control the activity of cells and organs.

How it is given

Bicalutamide is a tablet, which is taken once a day.

How it works

Most prostate cancers rely on supplies of the male hormone testosterone (which is produced by the testes and adrenal glands) to grow. On the surface of the prostate cancer cells are proteins called receptors. Bicalutamide has a structure similar to the male sex hormone testosterone. It works by blocking and preventing testosterone from attaching (binding) to the receptors on the surface of the prostate cancer cells.

The easiest way to understand the way bicalutamide works is to liken the process to that of a lock and key. The receptors are the lock and testosterone is the key. When testosterone comes into contact with the receptors it unlocks or activates the cancer cells to divide, and the tumour grows. Bicalutamide imitates the action of testosterone and fits into the lock but the key does not turn and the cells do not divide. The bicalutamide remains in place and prevents the testosterone from reaching the cancer cells so they either grow more slowly, or stop growing altogether. The cancer may shrink in size.

Bicalutamide may be used on its own to treat prostate cancer which is contained within the prostate gland, or the tissues around the prostate gland. In prostate cancer which has spread to other parts of the body, bicalutamide may be given on its own or together with injections of another type of hormonal therapy drug (goserelin, buserelin, triptorelin or leuprorelin). These drugs block the production of a hormone produced by the pituitary gland (luteinising hormone), which stimulates the production of testosterone.

Possible side effects

Each person's reaction to any medication is unique. Many people have very few side effects with bicalutamide while others may experience more. The side effects described here will not affect everyone and may be different if you are having more than one drug. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug but which are not listed here, please discuss these with your doctor or nurse.

You will see your doctor regularly while you have this treatment so that they can monitor the effects. This information should help you to discuss any queries about your treatment and its side effects with your doctor or nurse, as they are in the best position to help and advise you.

Some people may have some of the following side effects:

Breast tenderness or fullness. Some men may notice slight breast swelling and tenderness. Your doctor can prescribe medicines to reduce any discomfort.
Hot flushes. These are usually mild and may wear off after a period of time and become less of a problem. There are a number of ways to help reduce hot flushes and sweats. It can be useful to avoid or cut down on tea, coffee, nicotine and alcohol. Let your doctor know if hot flushes are causing you any problems as recent research suggests that progesterone or some anti-depressants may be very helpful in controlling this side effect.
Some people find that complementary therapies help, and your GP may be able to give you details about obtaining these on the NHS. CancerBACUP has information on Cancer and complementary therapies.
Itching and dryness of the skin. This is usually mild. Let your doctor know if it is a problem for you. Sometimes creams or medications reduce this effect.
Nausea (feeling of sickness), vomiting and mild diarrhoea. These are usually mild and easily controlled. Nausea can sometimes be relieved by taking the tablet with food. Let your doctor know if you have any of these side effects as medication can be prescribed to help. CancerBACUP's information on Diet and the cancer patient discusses ways of coping with these effects and information is also available on managing nausea and vomiting.
Lowering of libido (sex drive), and impotence (loss of ability to have an erection). If this occurs sexual function will return to normal after stopping the drug. Your doctor or nurse can discuss this with you.
Drowsiness and weakness. Occasionally bicalutamide may cause feelings of weakness and drowsiness.

Length of treatment

Your doctor will discuss the length of treatment that they feel is appropriate for your situation. It is often given for several months or years.

If you forget to take your tablet don't panic levels of the drug in your blood will not change very much but try not to miss more than one or two tablets in a row. Remember to get a new prescription a couple of weeks before you run out of tablets and make sure you have plenty for holidays etc.

Things to remember about bicalutamide tablets

Keep the tablets in a safe place where children cannot reach them, as bicalutamide could harm them.

If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.

If you are sick just after taking the tablet tell your doctor as you may need to take another one.

If you forget to take your tablet, do not take a double dose. Let your doctor or nurse know.

Bisphosphonates are a class of therapeutic agents originally designed to treat loss of bone density. It has been shown that the primary mechanism of action is inhibition of osteoclastic (Cell breakdown) activity. Accumulating data show that these drugs are useful in diseases with propensities toward osseous metastases (Spreading of cancer to other parts). In particular, they are effective in diseases in which there is clear upregulation of osteoclastic or osteolytic activity such as breast cancer and multiple myeloma. Despite the fact that osseous metastases in prostate cancer manifest as osteosclerosis rather than osteolysis, studies now show that bisphosphonates are useful in the management of this disease. In particular, they have demonstrated an impact on osteoporosis associated with hormonal therapy, bone pain from metastases, and skeleton-related events from prostatic adenocarcinoma. This review briefly summarizes the available clinical data on the utilization of bisphosphonates in the disease of prostate cancer.

1	The cross-talk among tumor cells, osteoclasts, and osteoblasts in the development of bone metastatic prostate cancer results in an imbalance in remodeling and subsequent fragile skeletal bone tissue as well as increased tumor growth in cells that have colonized bone tissue.
2	BMPs and RANK/RANKL mediate osteogenic activity, thereby making them attractive targets for disruption of bone disease progression.
3	Bone scintigraphy with Tc-99m tracer remains the standard of care for detection of bone metastases. Preliminary results with MRI, 18-F PET, and 18-F PET/CT have shown promise in improving sensitivity and specificity.
4	Administration of radiopharmaceuticals, such as strontium-89, samarium-153, and rhenium-188-HEDP, has demonstrated improvements in palliation and less damage to normal tissue compared with local radiation or hemibody radiation.
5	The potent bisphosphonate zoledronic acid has demonstrated an ability to reduce skeletal complications. Ongoing studies will address the role of earlier therapy.

1	Develop practice guidelines for the use of bisphosphonates in men initiating androgen deprivation therapy to prevent disruptions in bone metabolism and slow progression to bone metastatic disease.
2	Promote early diagnosis of bone metastatic disease by increased screening and thorough evaluations of patients with prostate cancer.
3	Encourage study of combination therapy with investigational and approved bone-targeted agents to stem the progression of bone metastases.
4	Develop criteria for conducting clinical trials in patients with bone metastatic disease with cytostatic agents, including clinically meaningful endpoints.
5	Promote enrollment in clinical trials by urologists, radiation oncologists, medical oncologists, and patients at all stages of prostate canc